Glossary of OSTEOPATHIC TERMINOLOGY Third Edition

glossary OF OSTEOPATHIC TERMINOLOGY Third Edition

Executive Editor Rebecca Giusti, DO

A / accessory movements / anatomical barrier / anterior component / articular pillar / articulatory technique / B / backward torsion / balanced ligamentous tension / biomechanics / C / cephalad / cerebrospinal fluid, fluctuation of / cervicolumbar reflex / contraction / D / deformation / depressed rib / E / effleurage / elastic deformation / elasticity / elevated rib / F / facet symmetry / fascial release technique / G / gait / glymphatic system / gravitational line / H / habituation / hip bone / homeostasis / Hoover technique / I / indirect method / innominate somatic dysfunctions / intersegmental motion / J / Jones technique / junctional region / K / key lesion / kinesthesia / klapping / kyphoscoliosis / L / lateroflexion / longitudinal axis / lordosis / lumbolumbar lordotic angle / lymphatic treatment / M / manipulation / manual medicine / models of osteopathic care / muscle energy technique / myofascial technique / N / neurotrophy / non-allopathic lesion / normalization / nutation / O / osteopathic musculoskeletal evaluation / osteopathic postural examination / osteopathic practitioner / osteopathic structural examination / P / palpatory skills / passive method / patient cooperation / pedal pump / plasticity / posterior component / R / respiratory cooperation / reciprocal inhibition / reflex / S / sacral torsion / sagittal plane / scan / scaphoid head / scoliosis / somatic dysfunction / Still technique / T / tapotement / tenderpoints / thoracic pump / thrust technique / trigger point / U / uncommon compensatory pattern / uncompensated fascial pattern / V / velocity / ventral technique / vertebral unit / visceral dysfunction / W / weight-bearing line of L3

® A print version of the 2017 Glossary of Osteopathic Terminology is available at www.aacom.org/resources/bookstore/Pages/glossary.aspx.

Copies of the Glossary are available for $15 each.

For larger orders:

1 – 10 copies: $15 each 11 – 49 copies: $12 each 50 and up: $9 each

Payment may be sent by check or money order to: Publications Orders: American Association of Colleges of Osteopathic Medicine Office of Communications and Marketing 5550 Friendship Blvd. Suite 310 Chevy Chase, MD 20815

Please note Glossary on your check or money order.

No part of this publication may be reproduced or transmitted in any form or by any means electronic or mechanical, including photocopying, recording, or by any information storage and retrieval system, without permission in writing from the publisher: American Association of Colleges of Osteopathic Medicine 5550 Friendship Blvd. Suite 310 Chevy Chase, MD 20815

TheGlossary of Osteopathic Terminology is developed and revised by the Educational Council on Osteopathic Principles (ECOP) of the American Association of Colleges of Osteopathic Medicine (AACOM) Chairman: Kendi Hensel, DO, PhD, of University of North Texas Health Science Center at Fort Worth/Texas College of Osteopathic Medicine. The Glossary Committee is chaired by Rebecca Giusti, DO, of Western University of Health Sciences/ College of Osteopathic Medicine of the Pacific, the Subcommittee Chair Laura Griffin, DO, FAAO of University of Pikeville–Kentucky College of Osteopathic Medicine and Past Committee Chair Walter Ehrenfeuchter, DO, FAAO, of Georgia Campus–Philadelphia College of Osteopathic Medicine and staffed by Tyler Cymet, DO, and Kate Hirsch. Any comments or suggestions should be sent to AACOM Staff Representative Tyler Cymet, DO, at 5550 Friendship Boulevard, Suite 310, Chevy Chase, MD 20815, or by email at [email protected].

TheGlossary of Osteopathic Terminology first appeared in the Journal of the American Osteopathic Association (JAOA) 80:552-567 in April 1981. The 1995 version of the Glossary of Osteopathic Terminology was also published in the textbook, Foundations for Osteopathic Medicine, Ward RC (ed.) (1997) pp. 1126-1140: Williams & Wilkins, Baltimore, MD, and in Foundations for Osteopathic Medicine, Ward.RC (ed.) (2003) pp. 1229-1253: Williams & Wilkins, Baltimore, MD. The most current and revised version is available on the AACOM website at www.aacom.org.

Glossary of Osteopathic Terminology, 2017 1 The 2017Glossary of Osteopathic Terminology review was performed by members of ECOP.

Contributing Members

Kendi Hensel, DO, PhD (Chair) Walter Ehrenfeuchter, DO, FAAO Anthony Will, DO (Vice Chair) David Eland, DO, FAAO Rebecca Giusti, DO (Secretary) John Garlitz, DO Ann L. Habenicht, DO, FAAO, Sharon Gustowski, DO FACOFP (Sergeant-at-Arms) John Glover, DO, FAAO John Jones, DO, MEd (Historian) Laura Griffin, DO, FAAO Tyler Cymet, DO (AACOM Claire Galin, DO Liaison) Shana Shoshy, DO Kate Hirsch (AACOM staff) Deborah Schmidt, DO Lisa R. Chun, DO, MS, FNAOME Kevin Hayes, DO Jose Figueroa, DO David Harden, DO Daniel Umberger, DO David Boesler, DO David Coffey, DO Kurt Heinking, DO, FAAO Douglas Weston, DO Jan Hendryx, DO, FAAO To Shan Li, DO James Kribs, DO Angela Branda, DO Evan Nicholas, DO Mark Thai, DO Paul Rennie, DO, FAAO Susan Miliani, DO Eric Snider, DO Thomas Fotopoulos, DO Stuart Williams, DO Kelly Halma, DO Kevin Treffer, DO ECOP acknowledges Jonathan Millicent King Channell, DO, FAAO Kirsch, DO, and Mark Sandhouse, Stacey Pierce-Talsma, DO DO, as well as all previous Victoria Troncoso, DO members for their contribution Lisa DeStefano, DO to the development of the current and past versions of Glossary of William Devine, DO Osteopathic Terminology. Heather Ferrill, DO Robin Dyer, DO

2 American Association of Colleges of Osteopathic Medicine Purpose

The purpose of this osteopathic glossary is to present important and frequently used words, terms, and phrases that are unique or with special significance to the osteopathic profession. It is not meant to replace a dictionary. The glossary offers the consensus of a large segment of the osteopathic profession and serves to standardize terminology. The ECOP Glossary Review Committee specifically seeks to include those definitions that are uniquely osteopathic in their origin or common usage, distinctive in the osteopathic usage of a common word, and/or important in describing OPP/OMT. This glossary should be useful to students of osteopathic medicine and helpful to authors and other professionals in understanding and making proper use of osteopathic vocabulary. Osteopathic treatment methods are a group of techniques that apply a set of distinct unifying principles that guide individualized treatment including high velocity, low amplitude (HVLA), muscle energy, osteopathic cranial manipulative medicine, counterstrain, myofascial release and soft tissue. “Methods” are described as being direct, indirect, or combined. Techniques are specific therapeutic manual procedures such as the Dalrymple pedal pump or the CV-4. The five models used in discussion of osteopathic patient care are 1) respiratory-circulatory, 2) biomechanical-structural, 3) metabolic-nutritional, 4) neurological, and 5) behavioral- biopsychosocial.

Glossary of Osteopathic Terminology, 2017 3

Introduction

Glossary of Osteopathic Terminology The third edition of theGlossary of Osteopathic Terminology (GOT) is an important accomplishment. The work of the Educational Council on Osteopathic Principles (ECOP) which represents the chairs or academic leads from the departments of osteopathic manipulative medicine at each of the colleges of osteopathic medicine is a consensus doc- ument that standardizes the words used to discuss osteopathic medicine across the country and the world. Words matter! While language can evolve, the glossary of osteopathic terminology is a standard brings in the quality of consistency and accuracy when practicing, discussing and assessing students in the field of osteopathic medicine. Our goal in defining these terms is so that these terms are used correctly and consistently. The other goal is to facilitate communication and to sharpen the accuracy in communication. The definitions here will help people say what they mean by defining the words you need. In between editions of the Glossary of Osteopathic Terminology, ECOP accepts questions on definitions, proposals of words that need to be defined, or challenges and requests to modify definitions. Those comments can be shared through this site: https://www.aacom.org/docs/default-source/councils/ glossary_guidelines.pdf?sfvrsn=0 We hope you come to depend on the glossary. Tyler Cymet, DO, FACP, FACOFP Chief of Clinical Education, AACOM ECOP Staff Liaison

Glossary of Osteopathic Terminology, 2017 5

angle (lumbosacral angle)

A anatomical barrier. See barrier, motion. accessory joint motions. See angle. secondary joint motion. –ferguson angle. See angle, accessory movements. lumbosacral. Movements used to potentiate, –lumbolumbar lordotic angle. accentuate, or compensate for An objective quantification an impairment in a physiologic of lumbar lordosis typically motion (e.g., the movements determined by measuring the needed to move a paralyzed angle between the superior limb). surface of the second lumbar accommodation. A self-reversing vertebra and the inferior and non-persistent adaptation. surface of the fifth lumbar vertebra; best measured from active motion. See motion, active. a standing lateral x-ray film. acute somatic dysfunction. See (Fig. 1) somatic dysfunction, acute. adaptation. A responsive alteration or adjustment in the reciprocal relationship between structure and function, by which an individual is able to better accommodate changes in its environment. allopathy. A therapeutic system in which a disease is treated by producing a second condition that is incompatible with or antagonistic to the first. (Dorland’s) See also allopath, allopathic physician –lumbosacral angle. Also called allopath, allopathic physician. Ferguson’s angle. Represents (1) A term originated by Samuel the angle of the lumbosacral Hahnemann, MD, to distinguish junction as measured by the homeopaths from physicians inclination of the superior practicing traditional/orthodox surface of the first sacral medicine. (2) In common usage a vertebra to the horizontal general term used to differentiate (this is actually a sacral angle); MDs (medical doctors) from usually measured from other schools of medicine.

Glossary of Osteopathic Terminology, 2017 7 angle (lumbosacral lordotic angle)

standing lateral x-ray films. anterior component. A positional (Fig. 2) descriptor used to identify the side of reference when rotation of a vertebra has occurred; in a condition of right rotation, the left side is the anterior component; usually refers to the less prominent transverse process; See also posterior component. anterior iliac rotation. See innominate somatic dysfunction of, anterior innominate rotation. anterior nutation. See nutation. anterior rib. See rib somatic dysfunction; inhaled rib somatic –lumbosacral lordotic angle. dysfunction. An objective quantification of lumbar lordosis typically determined by measuring the angle between the superior surface of the second lumbar vertebra and the superior surface of the first sacral segment; best measured from a standing lateral x-ray film. (Fig. 3)

anterior superior iliac spine (ASIS) compression test. Also called ASIS ilial compression test. (1) A test for lateralization of somatic dysfunction of the sacrum, innominate, or pubic symphysis. (2) Application of a force through the ASIS into one of the pelvic axes to assess the mechanics of the pelvis. See also sacral motion, axis of. (Fig. 4)

8 American Association of Colleges of Osteopathic Medicine balance point articular pillar. (1) Refers to the of the TART acronym for an columnar arrangement of the osteopathic somatic dysfunction. articular portions of the cervical axis. (1) An imaginary line about vertebrae. (2) Those parts of which motion occurs. (2) The the lateral arches of the cervical second cervical vertebra. (3) One vertebrae that contain a superior component of an axis system. and inferior articular facet. axis of rib motion. See rib motion, articulation. (1) The place of axis of rib motion. union or junction between two or more bones of the skeleton. axis of sacral motion. See sacral (2) The active or passive process movement axis. of moving a joint through its axoplasmic flow.See axoplasmic permitted anatomic range of transport. motion. See also osteopathic manipulative treatment method, axoplasmic transport. The articulatory. antegrade movement of substances from the nerve articulatory pop. The sound made cell along the axon toward the when cavitation occurs in a joint. terminals toward the nerve cell. See also cavitation. anterior compression test. See anterior superior iliac spine B compression test. ART. See osteopathic backward bending. Opposite manipulative treatment, of forward bending. See also articulatory. extension. articulation. See osteopathic backward bending test. (1) This manipulative treatment, test discriminates between articulatory method (ART). forward and backward sacral ASIS compression test. See torsion/rotation. (2) This test anterior superior iliac spine discriminates between unilateral compression test. sacral flexion and unilateral sacral extension. asymmetry. Absence of symmetry of position or motion; backward torsion. See sacrum, dissimilarity in corresponding somatic dysfunctions of, parts or organs on opposite sides backward torsions. of the body that are normally balance point. The position alike; of particular use when at which the tension within describing position or motion the tissues is symmetrically alteration resulting from somatic distributed. See neutral. dysfunction. This term is part

Glossary of Osteopathic Terminology, 2017 9 balance ligamentous tension (BLT) balanced ligamentous tension in which passive ligamentous (BLT). (1) The precise physiologic stretching occurs before tissue point in which the proprioceptive disruption. information provided by the –pathologic barrier. A ligaments allows the body to restriction of joint motion equalize the stresses exerted associated with pathologic on an articulation in all change of tissues (example. directions. (2) First described osteophytes). See also barrier, in “Osteopathic Technique of restrictive barrier. William G. Sutherland, DO” that was published in the –physiologic barrier. The limit 1949 Year Book of Academy of of active motion. Applied Osteopathy. See also –restrictive barrier. A ligamentous articular strain. See functional limit that also osteopathic manipulative abnormally diminishes the treatment, balanced ligamentous normal physiologic range. tension. batwing deformity. See balanced membranous tension transitional vertebrae, (BMT). The precise physiologic sacralization. point in which the proprioceptive bind. Palpable resistance to information provided by the motion of an articulation or dural membranes and sutures tissue. Synonym. resistance. allows the body to equalize Antonyms. ease, compliance, the stresses exerted on those resilience. structures in all directions. See also osteopathic manipulative biomechanics. Mechanical treatment, balanced principles applied to the study membranous tension. See also of biological functions; the osteopathic cranial manipulative application of mechanical laws medicine (OCMM). to living structures; the study and knowledge of biological barrier (motion barrier). The function from an application of limit to motion; in defining mechanical principles. barriers, the palpatory end-feel characteristics are useful. (Fig. 5) BLT. See balanced ligamentous –anatomic(al) barrier. The tension. limit of motion imposed by BMT. See balanced membranous anatomic structure; the limit of tension. passive motion. body unity. One of the basic tenets –elastic barrier. The range of the osteopathic philosophy; between the physiologic and the human being is a dynamic anatomic barrier of motion

10 American Association of Colleges of Osteopathic Medicine cephalad pubic dysfunction

unit of function; See also osteopathic philosophy. bogginess. A tissue texture abnormality characterized principally by a palpable sense of sponginess in the tissue, interpreted as resulting from congestion due to increased fluid content. bucket handle rib motion. See rib motion, bucket handle.

caliper rib motion. See rib motion, caliper rib motion. caudad. Toward the tail or inferiorly. caught in exhalation. See rib somatic dysfunction, exhaled rib dysfunction. caught in inhalation. See rib somatic dysfunction, inhaled rib dysfunction. cavitation. The formation of small vapor and gas bubbles within fluid caused by local reduction in pressure. This phenomenon is believed to produce an audible “pop” in certain forms of osteopathic medical treatment. CCP. See fascial patterns, common compensatory pattern. cephalad. Toward the head. cephalad pubic dysfunction. See pubic bone, somatic dysfunctions of, superior pubic shear.

Glossary of Osteopathic Terminology, 2017 11 cerebrospinal fluid, fluctuation of cerebrospinal fluid, fluctuation of. Chapman, DO, and described by A description of the hypothesized Charles Owens, DO. action of cerebrospinal fluid chronic somatic dysfunction. See with regard to the craniosacral somatic dysfunction, chronic mechanism. somatic dysfunction. Certification in circumduction. (1) The circular Neuromusculoskeletal Medicine movement of a limb. (2) The and Osteopathic Manipulative rotary movement by which a Medicine (C-NMM/OMM). structure is made to describe a Certification is granted by cone, the apex of the cone being the American Osteopathic a fixed point (e.g., the circular Association (AOA) through movement of the shoulder). the American Osteopathic Board of Neuromusculoskeletal C-NMM/OMM. See Certification in Medicine (AOBNMM). First Neuromusculoskeletal Medicine granted in 1999. See also and Osteopathic Manipulative Neuromusculoskeletal Medicine Medicine. (NMM). combined technique. See Certification in Special osteopathic manipulative Proficiency in Osteopathic treatment, combined treatment Manipulative Medicine method. (C-SPOMM). Specialty board common compensatory pattern. Certification in Osteopathic See fascial patterns, common Manipulative Medicine prior compensatory pattern. to 1999. A certification granted by the American Osteopathic compensation. A process in which Association through the there is an adaptive response American Osteopathic Board to any alteration of structure of Special Proficiency in OMM. or function in an attempt to Replaced by C-NMM/OMM in optimize health. that year. See also C-NMM/OMM. complete motor asymmetry. cervicolumbar reflex. See reflex, Asymmetry of palpatory cervicolumbar. responses to all regional motion inputs including rotation, Chapman reflex.(1) A group translation, and active respiration. of palpable points occurring in predictable locations on compliance. (1) The ease with the anterior and posterior which a tissue may be deformed. surfaces of the body that are (2) Direction of ease in motion considered to be reflections of testing. visceral dysfunction or disease compression. (1) Somatic (2) Originally used by Frank dysfunction in which two

12 American Association of Colleges of Osteopathic Medicine counterstrain point structures are forced together. in which a constant force is (2) A force that approximates applied. (2) Operator force less two structures. than patient force. compression of the fourth contracted muscle. The ventricle (CV-4). See osteopathic physiologic response to a manipulative treatment, (CV-4). neuromuscular excitation. See See also osteopathic cranial also contractured muscle. manipulative medicine. contractured muscle. conditioned reflex. See reflex, Histological change substituting conditioned. non-contractile tissue for muscle tissue, which prevents the muscle contraction. Shortening and/or from reaching normal relaxed development of tension in muscle. length. See also contracted muscle. –concentric contraction. Contraction of muscle resulting core link. The connection of in approximation of attachments. the spinal dura mater from the occiput at the foramen magnum –eccentric contraction. to the sacrum. It coordinates the Lengthening of muscle during synchronous motion of these contraction due to an external two structures. force. –isokinetic contraction. (1) A coronal plane. See plane, coronal concentric contraction against plane. resistance in which the angular costal dysfunction. See rib, change of joint motion is at the somatic dysfunction. same rate. (2) The counterforce is less than the patient force. counternutation. Posterior movement of the sacral base –isolytic contraction. (1) A around a transverse axis in relation form of eccentric contraction to the ilia. See also nutation. designed to break adhesions using an operator-induced counterstrain technique. force to lengthen the muscle. See osteopathic manipulative (2) The counterforce is greater treatment, counterstrain. than the patient force. counterstrain point. (1) A discrete –isometric contraction. (1) area of tissue texture abnormality Change in the tension of a which often exhibits tenderness muscle without approximation and responds to a positional of muscle origin and insertion. release technique. (2) Points (2) Operator force equal to used in counterstrain technique patient force. developed by Lawrence Jones, –isotonic contraction. (1) A DO. See also tenderpoints. See form of concentric contraction also osteopathic manipulative treatment, counterstrain. Glossary of Osteopathic Terminology, 2017 13 cranial manipulation cranial manipulation. CV-4. See osteopathic See osteopathic cranial manipulative treatment, manipulative medicine. See compression of the fourth also osteopathic manipulative ventricle (CV-4). treatment method, osteopathic cranial manipulative medicine. cranial rhythmic impulse Also D called CRI. (1) A rhythmic fluctuation palpable throughout Dalrymple treatment. See the entire body believed to be osteopathic manipulative synchronous with the primary treatment, pedal pump. respiratory mechanism. (2) Term decompensation. A dysfunctional, coined by John Woods, DO, and persistent pattern, in some Rachel Woods, DO. cases reversible, resulting when cranial technique. See osteopathic homeostatic mechanisms are manipulative treatment, partially or totally overwhelmed. osteopathic cranial manipulative deformation. medicine. See also primary respiratory mechanism. –plastic deformation. A non- recoverable deformation. craniosacral manipulation. See also elastic deformation. See osteopathic manipulative –elastic deformation. Any treatment, osteopathic cranial recoverable deformation. manipulative medicine. See also plastic deformation. craniosacral mechanism. depressed rib. See rib somatic (1) A term used to refer to the dysfunction, exhaled rib anatomical connection between dysfunction. See also exhaled rib the occiput and the sacrum by dysfunction. the spinal dura mater. (2) A term coined by William G. Sutherland, dermatome. (1) The area of skin DO. See extension, sacral. See supplied by cutaneous branches also flexion.See also primary from a single spinal nerve. respiratory mechanism. (Neighboring dermatomes may overlap) (2) Cutis plate; the creep. The capacity of fascia dorsolateral part of an embryonic and other tissue to lengthen when somite. (Fig. 6 and Fig. 7) subjected to a constant tension load resulting in less resistance to diagnostic palpation. See a second load application. palpatory diagnosis. C-SPOMM. See Certification in diagonal axis. See sacral Special Proficiency in Osteopathic movement axis, oblique axis Manipulative Medicine. (diagonal).

14 American Association of Colleges of Osteopathic Medicine DO direct method (technique). accredited by the American See osteopathic manipulative Osteopathic Association-COCA). treatment, direct treatment. (3) Diplomate in Osteopathy (the first degree granted by DO. (1) Doctor of Osteopathy American School of Osteopathy). (graduate of a school accredited (4) Diplomate of Osteopathy, by the American Osteopathic a degree granted by some Association Commission on schools of osteopathy outside Osteopathic College Accreditation the United States (not accredited [COCA]). (2) Doctor of Osteopathic by the American Osteopathic Medicine (graduate of a school Association-COCA).

Glossary of Osteopathic Terminology, 2017 15 ease

E elevated rib. See rib somatic dysfunction, inhalation rib ease. Relative palpable freedom dysfunction. See also rib motion, of motion of an articulation or exhalation rib restriction. tissue. Synonyms. compliance, end feel. Perceived quality of resilience. Antonyms. bind, motion as an anatomic or resistance. physiologic restrictive barrier easy normal. See neutral, is approached. definition #2. enthesitis. (1) Traumatic disease -ed. A suffix describing status, occurring at the insertion position, or condition (e.g., of muscles where recurring extended, flexed, rotated, concentration of muscle stress restricted). provokes inflammation with a strong tendency toward ECOP. See Educational Council on fibrosis and calcification. (2) Osteopathic Principles. Inflammation of the muscular or Educational Council on tendinous attachment to bone. Osteopathic Principles (ECOP). ERS. A descriptor of spinal A component group of the somatic dysfunction used to American Association of Colleges denote a combination extended of Osteopathic Medicine (E), rotated (R), and sidebent (S) (AACOM). The council is vertebral position. composed of one representative –ERS left. Somatic dysfunction from each osteopathic medical in which the vertebral unit is school who oversee the teaching extended, rotated and sidebent of osteopathic principles and left; usually preceded by a practice, including osteopathic designation of the vertebral manipulative treatment at each unit(s) involved (e.g., T5 ERS institution. left or T5 ERLSL). effleurage. Stroking movement –ERS right. Somatic used to move fluids. dysfunction in which the elastic deformation. See vertebral unit is extended, deformation, elastic. rotated and sidebent right; usually preceded by a elasticity. Ability of a strained designation of the vertebral body or tissue to recover its unit(s) involved (e.g., C3-5 ERS original shape after deformation. right or C3-5 ERRSR). See also plasticity; viscosity. exaggeration treatment method. See osteopathic manipulative treatment, exaggeration.

16 American Association of Colleges of Osteopathic Medicine extrinsic corrective forces

exaggeration technique. See osteopathic manipulative treatment, exaggeration technique. exhalation rib dysfunction. See rib somatic dysfunction, exhalation rib dysfunction. exhalation rib restriction. See rib somatic dysfunction, inhaled rib dysfunction. exhaled rib. Historic term, using positional (static) diagnosis. See rib somatic dysfunction, inhaled somatic dysfunction. extension. (1) Accepted universal term for backward motion of the spine in the sagittal plane about a transverse axis; in a vertebral unit when the superior part moves backward. (2) In extremities, it is the straightening of a curve or angle (biomechanics). (3) Historic term, separation of the ends of a curve in a spinal region. –regional extension. Also called Fryette’s regional extension (Fig. 9). Historically, the straightening in the sagittal plane of a spinal region. –sacral extension. (1) Posterior movement of the base of the sacrum in relation to the ilia (Fig. 10). See also flexion, sacral. extrinsic corrective forces. Treatment forces external to the patient that may include operator effort, effect of gravity, mechanical tables, etc. See also intrinsic corrective forces.

Glossary of Osteopathic Terminology, 2017 17 FAAO

facilitated segment. See spinal facilitation. facilitation. See spinal facilitation. fascial patterns. (1) Systems for classifying and recording the preferred directions of fascial motion throughout the body. (2) Based on the observations of J. Gordon Zink, DO, and W. Neidner, DO. –common compensatory pattern (CCP). The specific finding of alternating fascial motion preference at transitional regions of the body described by Zink and Neidner. (Fig. 11) –uncommon compensatory pattern. The finding of alternating fascial motion preference in the direction F opposite that of the common compensatory pattern FAAO. See Fellow of American described by Zink and Neidner. Academy of Osteopathy (Fig. 12) facet asymmetry. Configuration –uncompensated fascial in which the structure, position, pattern. The finding of fascial and/or motion of the facets are preferences that do not not equal bilaterally. See also demonstrate alternating facet symmetry; tropism, facet. patterns of findings at facet symmetry. Configuration transitional regions. Clinically in which the structure, position, this generally occurs following and/or motion of the facets are postural stress or trauma equal bilaterally. See also facet and is frequently associated asymmetry; symmetry. with development of symptomatology. facilitated positional release. See osteopathic manipulative fascial release technique. See treatment, facilitated positional osteopathic manipulative release. treatment, myofascial release.

18 American Association of Colleges of Osteopathic Medicine flexion/sacral flexion

to osteopathic principles and practice through teaching, writing, and service, performed at the highest level of professional and ethical standards. Ferguson angle. See angle, lumbosacral. flexion. Also called Fryette’s regional flexion. (1) Accepted universal term for forward motion of the spine, in its sagittal plane about a transverse axis, where the superior part moves forward. (2) In the extremities, it is the approximation of a curve or angle (biomechanics). (3) In osteopathic cranial manipulative medicine, flexion is said to occur when the sacral base moves postero-superiorly as the sphenobasilar synchondrosis (SBS) ascends and angulates during the inhalation phase of the primary respiratory mechanism. (Fig. 13) (4) Approximation of the ends of a curve in a spinal region. See flexion, regional flexion. –regional flexion. Also called Fryette’s regional flexion. Historically, is the fascial unwinding. See approximation of the ends of osteopathic manipulative a curve in the sagittal plane of treatment, fascial unwinding. the spine. See flexion. (Fig. 14) Fellow of American Academy of Osteopathy (FAAO). This –sacral flexion. Anterior earned post-doctoral fellowship movement of sacral base in is conferred by the American relation to the ilia. (Fig. 15) Academy of Osteopathy. Those See also extension, sacral who earn the FAAO must extension. demonstrate their commitment

Glossary of Osteopathic Terminology, 2017 19 flexion/flexion, left

–flexion left.See sidebending. –flexion right. See sidebending. flexion tests. Tests for iliosacral or sacroiliac somatic dysfunction.

–seated flexion test.A screening test that determines the side of sacroiliac somatic (Osteopathic Cranial dysfunction (motion of the Manipulative Medicine) sacrum on the ilium). –standing flexion test. A screening test that determines the side of iliosacral somatic dysfunction (motion of ilium on the sacrum). forward bending. Reciprocal of backward bending. See also flexion. forward torsions. See sacrum, somatic dysfunctions of, forward torsions. FRS. A descriptor of spinal somatic dysfunction used to denote a combination flexed (F), rotated (R), and sidebent (S) vertebral position.

20 American Association of Colleges of Osteopathic Medicine glymphatic system

–FRS left. A somatic G dysfunction in which the vertebral unit is flexed, rotated, gait. A forward translation of and sidebent left; usually the body’s center of gravity by preceded by a designation of bipedal locomotion. the vertebral unit(s) involved (e.g., T5 FRS left or T5 FRLSL). Galbreath treatment technique. –FRS right. A somatic See osteopathic manipulative dysfunction in which the treatment, mandibular drainage. vertebral unit is flexed, rotated, glymphatic system. A network of and sidebent right; usually channels formed by glia in the preceded by a designation of central nervous system which the vertebral unit(s) involved functions as a waste clearance (e.g., C3-5 FRS right or C3-5 pathway for cerebrospinal fluid, FRRSR). frontal plane. See plane, coronal plane. Fryette laws. See physiologic motion of the spine. Fryette principles. See physiologic motion of the spine. Fryette regional extension. See extension, regional extension. Fryette regional flexion. See flexion, regional flexion. FSR. A descriptor of spinal somatic dysfunction used to denote a combination flexed (F), sidebent (S), and rotated (R) vertebral position. See FRS. functional treatment method. See osteopathic manipulative treatment, functional treatment. functional technique. See osteopathic manipulative treatment, functional treatment method.

Glossary of Osteopathic Terminology, 2017 21 gravitaional line interstitial fluid, and interstitial treatment, high velocity low solutes. amplitude. gravitational line. Viewing hip bone. See innominate. the patient from the side, an See also innominate, somatic imaginary line in a coronal plane dysfunctions of. which, in the theoretical ideal homeostasis. (1) Maintenance posture, starts slightly anterior of static or constant conditions to the lateral malleolus, passes in the internal environment. across the lateral condyle of the (2) The level of well-being of an knee, the greater trochanter, individual maintained by internal through the lateral head of physiologic harmony that is the humerus at the tip of the the result of a relatively stable shoulder to the external auditory state or equilibrium among the meatus; if this were a plane interdependent body functions. through the body, it would intersect the middle of the third homeostatic mechanism. A lumbar vertebra and the anterior system of control activated by one third of the sacrum. It is used negative feedback. to evaluate the A-P (anterior- Hoover technique. See osteopathic posterior) curves of the spine. manipulative treatment, Hoover See also mid-malleolar line. technique. (Fig. 16) hysteresis. During the loading and unloading of connective tissue, the restoration of the final H length of the tissue occurs at a rate and to an extent less than during deformation (loading). habituation. Decreased These differences represent physiologic response to repeated energy loss in the connective stimulation. tissue system. This difference in health. Adaptive and optimal viscoelastic behavior (and energy attainment of physical, mental, loss) is known as hysteresis (or emotional, spiritual, and “stress-strain”). environmental well-being. hypertonicity. A condition hepatic pump. See osteopathic of excessive resting tone of manipulative treatment, hepatic skeletal muscle characterized pump. by increased resistance of the muscle to passive stretching. high velocity low amplitude treatment method (HVLA). See HVLA. High velocity low osteopathic manipulative amplitude. See osteopathic

22 American Association of Colleges of Osteopathic Medicine innominate somatic dysfunctions/anterior innominate rotation manipulative treatment, high inferior lateral angle of the velocity low amplitude. sacrum (ILA). See sacrum, inferior lateral angle. inferior pubis. See pubic bone, somatic dysfunctions of, inferior I pubic shear. inferior transverse axis. See I/IND. Indirect method. See sacral movement axis, inferior osteopathic manipulative transverse axis. treatment, indirect method. inhalation rib. See rib somatic ILA. Inferior lateral angle of the dysfunction, inhalation rib sacrum. See sacrum, inferior dysfunction. lateral angle of. inhalation rib restriction. See rib ilia. The plural of ilium.See ilium. somatic dysfunction, exhalation ilial compression test. See rib dysfunction. anterior superior iliac spine inhibition. See osteopathic (ASIS) compression test. manipulative treatment, ilial rocking test. See anterior inhibitory pressure. superior iliac spine (ASIS) inhibitory pressure technique. compression test. See osteopathic manipulative iliosacral motion. Motion of one treatment, inhibitory pressure. innominate (ilium) with respect innominate. Also called the os to the sacrum. Iliosacral motion coxa, hip bone, or pelvic bone. is part of pelvic motion during One of two large, irregularly the gait cycle. shaped bones of the pelvis. Each iliosacral dysfunction. consists of three parts: ilium, See innominate somatic ischium, and pubis. dysfunctions. innominate rotation. Rotational ilium. The expansive superior motion of one innominate bone portion of the innominate relative to the sacrum about the (hip bone or os coxa). See also inferior transverse axis. innominate. innominate somatic dysfunctions. indirect method. See osteopathic –anterior innominate rotation. A manipulative treatment, indirect somatic dysfunction in which method. the innominate bone is rotated inferior ilium. See innominate, anteriorly around a transverse somatic dysfunctions of, inferior axis relative to the sacrum. innominate shear. The innominate moves more

Glossary of Osteopathic Terminology, 2017 23 innominate somatic dysfunctions/downslipped innominate

freely in anterior rotation compared to the contralateral and is restricted in posterior landmarks. (Fig. 18) rotation. The anterior superior iliac spine (ASIS) is positioned inferiorly and the posterior superior iliac spine (PSIS) is positioned superiorly when compared to the contralateral landmarks.(Fig. 17)

–inflared innominate. A somatic dysfunction in which the innominate bone becomes restricted such that the anterior superior iliac spine (ASIS) moves more freely in a medial direction –downslipped innominate. See and is restricted in the lateral inferior innominate shear. direction. The anterior superior –inferior innominate shear. A iliac spine (ASIS) is positioned somatic dysfunction in which medially and the posterior the innominate bone translates superior iliac spine (PSIS) inferiorly relative to the sacrum is positioned laterally with and becomes restricted. The respect to the midline when innominate moves more compared to the contralateral freely in inferior translation landmarks. (Fig. 19) and is restricted in superior –outflared innominate.A translation. The anterior somatic dysfunction in superior iliac spine (ASIS), which the innominate bone posterior superior iliac spine becomes restricted such that (PSIS), and ischial tuberosity the anterior superior iliac are positioned inferiorly when spine (ASIS) moves more

24 American Association of Colleges of Osteopathic Medicine integrated neuromusculoskeletal/superior innominate shear

–posterior innominate rotation. A somatic dysfunction in which the innominate bone is rotated posteriorly around a transverse axis relative to the sacrum. The innominate moves more freely in posterior rotation and is restricted in anterior rotation. The anterior superior iliac spine (ASIS) is positioned superiorly and the posterior superior iliac spine (PSIS) is positioned inferiorly when compared to the contralateral landmarks. (Fig. 21)

freely in a lateral direction –superior innominate shear. and is restricted in the A somatic dysfunction in medial direction. The ASIS which the innominate bone is positioned laterally and translates superiorly relative the posterior superior iliac to the sacrum and becomes spine (PSIS) is positioned restricted. The innominate medially with respect to the moves more freely in superior midline when compared to translation and is restricted the contralateral landmarks. in inferior translation. The (Fig. 20) anterior superior iliac spine

Glossary of Osteopathic Terminology, 2017 25 integrated neuromusculoskeletal/upslipped innominate

(ASIS), posterior superior intrinsic corrective forces. iliac spine (PSIS), and ischial Voluntary or involuntary forces tuberosity are positioned from within the patient that assist superiorly when compared to in the manipulative treatment the contralateral landmarks. process. See also extrinsic (Fig. 22) corrective forces. isokinetic exercise. Exercise using a constant speed of movement of the body part. isolytic contraction. See contraction, isolytic. isometric contraction. See contraction, isometric. isotonic contraction. See contraction, isotonic.

Jones technique. See osteopathic manipulative treatment, counterstrain. junctional region. See transitional –upslipped innominate. See region. superior innominate shear. integrated neuromusculoskeletal release. See osteopathic K manipulative treatment, integrated neuromusculoskeletal key lesion. See somatic release. dysfunction, primary. intersegmental motion. kinesthesia. The sense by which Designates relative motion taking muscular motion, weight, place between two adjacent position, etc. are perceived. vertebral segments or within a kinesthetic. Pertaining to vertebral unit that is described kinesthesia. as the upper vertebral segment moving on the lower. kinetics. The body of knowledge that deals with the effects of

26 American Association of Colleges of Osteopathic Medicine law/Wolff Law forces that produce or modify lateroflexion. See sidebending. body motion. law. klapping. Striking the skin –Fryette law of motion. See with cupped palms to produce physiologic motion of the vibrations with the intention of spine. loosening material in the lumen of hollow tubes or sacs within the –Head Law. When a painful body, particularly the lungs. stimulus is applied to a body part of low sensitivity (e.g., kneading. A soft tissue technique viscus) that is in close central that utilizes an intermittent force connection with a point of applied perpendicular to the long higher sensitivity (e.g., soma), axis of the muscle. the pain is felt at the point of kyphoscoliosis. A spinal curve higher sensitivity rather than pattern combining kyphosis at the point where the stimulus and scoliosis. See also kyphosis; was applied. scoliosis. –Sherrington Law. (1) Every posterior spinal nerve root kyphosis. (1) The exaggerated supplies a specific region of (pathologic) or normal A-P the skin, although fibers from (anteroposterior) curve of the adjacent spinal segments thoracic spine with concavity may invade such a region. anteriorly. (2) Abnormally (2) When a muscle receives increased convexity in the a nerve impulse to contract, curvature of the thoracic spine in its antagonist receives, the lateral view. simultaneously, an impulse kyphotic. Pertaining to or to relax. These are only two of characterized by kyphosis. See Sherrington’s contributions also kyphosis. to neurophysiology; these are the ones most relevant to osteopathic principles. L –Wolff Law. Every change in form and function of a bone, lateral flexed vertebral body. See or in its function alone, is sidebent. followed by certain definite changes in its internal lateral flexion. Also called architecture, and secondary lateroflexion.See sidebending. alterations in its external lateral masses (of the atlas). The conformations (e.g., bone is bulkiest and solid parts of the laid down along lines of stress). atlas that support the weight of (Stedman’s) the head.

Glossary of Osteopathic Terminology, 2017 27 lesion (osteopathic) lesion (osteopathic). Historic (compression, distraction, or term used to describe somatic torsion) by the osteopathic dysfunction. See somatic practitioner directed to a specific dysfunction. anatomic structure or tissue. ligamentous. localization. (1) In manipulative –ligamentous articular technique, the precise strain (LAS). Any somatic positioning of the patient and dysfunction resulting in vector application of forces abnormal ligamentous tension required to produce a desired or strain. See also osteopathic result. (2) The reference of a manipulative treatment, sensation to a particular locality ligamentous articular strain in the body. technique. longitudinal axis. See sacral – ligamentous articular motion axis, longitudinal axis. strain technique (LAS). See lordosis. The anterior convexity osteopathic manipulative in the curvature of the lumbar treatment, ligamentous and cervical spine as viewed from articular strain technique. the lateral view. The term is used –strain ligamentous. Motion to refer to both an abnormally and/or positional asymmetry increased curvature (also called associated with elastic hollow back, saddle back, deformation of connective sway back) and to the normal tissue (fascia, ligament, curvature (normal lordosis). membrane). See strain; ligamentous articular strain. lordotic. Pertaining to or characterized by lordosis. line of gravity. See gravitational line. lumbarization. See transitional vertebrae, lumbarization. linkage. A somatic dysfunctional segmental behavior where a lumbolumbar lordotic angle. See single vertebra and an adjacent angle, lumbolumbar lordotic. rib respond to the same regional lumbosacral angle. See angle, motion tests with identical lumbosacral. asymmetric behaviors (rather than opposing behaviors). This lumbosacral lordotic angle. See suggests visceral reflex inputs. angle, lumbosacral lordotic. liver pump. See osteopathic lumbosacral spring test. See manipulative treatment, hepatic spring test. pump technique. lymphatic pumps. See osteopathic load. The application of manipulative treatment, a biomechanical force lymphatic pump. See also

28 American Association of Colleges of Osteopathic Medicine mirror-image motion asymmetries osteopathic manipulative body. See also osteopathic treatment, pedal pump. See manipulative treatment, soft also osteopathic manipulative tissue treatment method. treatment, thoracic pump membranous articular strain. technique. Any cranial somatic dysfunction lymphatic treatment. See resulting in abnormal dural osteopathic manipulative membrane tensions. treatment, lymphatic technique. membranous balance. The ideal physiologic state of harmonious equilibrium in the tension of M the dura mater of the brain and spinal cord. mandibular drainage technique. mesenteric lift. See osteopathic See osteopathic manipulative manipulative treatment, treatment, mandibular drainage mesenteric release technique. technique. mesenteric release technique. manipulation. Therapeutic See osteopathic manipulative application of manual force. treatment, mesenteric release See also technique; osteopathic technique. manipulative treatment. middle transverse axis. See sacral manual medicine. (1) The skillful motion axis, middle transverse use of the hands to diagnose and axis (postural). treat structural and functional abnormalities in various tissues mid-heel line. A vertical line and organs throughout the body, used as a reference in standing including bones, joints, muscles, antero-posterior (A-P) x-rays and other soft tissues as an and postural evaluation, passing integral part of complete medical equidistant between the heels. care. (2) This term originated mid-gravitational line. See from the German Manuelle gravitational line. Medizin (manual medicine) and has been used interchangeably mid-malleolar line. A vertical with the term manipulation. line passing through the lateral (3) This term is not identical malleolus, used as a point of to manual therapy, which has reference in standing lateral been used by non-physician x-rays and postural evaluation. practitioners (e.g., physical See also gravitational line. therapists). mirror-image motion asymmetries. massage. Therapeutic friction, A grouping of primary and stroking, and kneading of the secondary sites of somatic

Glossary of Osteopathic Terminology, 2017 29 mobile point dysfunction describing a three- seeks to influence a patient’s segment complex fundamental physiological processes. to dysfunction in a mobile –behavioral model. The goal system. Each adjacent segment, of this model is to improve above and below the primary the biological, psychological, locus, demonstrates opposing and social components of the asymmetries to that locus. health spectrum. This includes For example, if the primary emotional balancing and locus resists rotation right, the compensatory mechanisms. segments above and below resist Reproductive processes and rotation left. behavioral adaption are also mobile point. In counterstrain, included under this model. the final position of treatment at –metabolic model. The goal which tenderness is no longer of the metabolic model is to elicited by palpation of the tender enhance the self- regulatory point. See also counterstrain. and self-healing mechanisms, mobile segment. A term in to foster energy conservation functional methods to describe a by balancing the body’s bony structure with its articular energy expenditure and surfaces and adnexal tissues exchange, and to enhance (neuromuscular and connective) immune system function, for segmental motion which endocrine function, and organ affects movement, stabilizes function. The osteopathic position, and allows coordinated considerations in this area are participation in passive not manipulative in nature movement. except for the use of lymphatic pump techniques. Nutritional mobile system. An osteopathic counseling, diet, and exercise construct associated with advice are the most common functional methods in which approaches to balancing the the body as a whole is viewed body through this model. as a centrally integrated system –neurologic model. The goal in which all of the individual of the neurologic model is elements (e.g., mobile segments) to attain autonomic balance have coordinated and specific and address neural reflex motion characteristics. See activity, remove facilitated also osteopathic manipulative segments, decrease afferent treatment, functional method. nerve signals and relieve pain. mobile unit. See mobile segment. The osteopathic manipulative techniques used to influence models of osteopathic care. this area of patient health Five models that articulate how an osteopathic practitioner

30 American Association of Colleges of Osteopathic Medicine myogenic tonus

include counterstrain and –active motion. Movement Chapman reflex points. produced voluntarily by the –respiratory-circulatory model. patient. The goal of the respiratory- –inherent motion. Spontaneous circulatory model is to motion of every cell, organ, improve all of the diaphragm system, and their component restrictions in the body. units within the body. Diaphragms are considered to –passive motion. Motion be “transverse restrictors” of induced by the osteopathic motion, venous and lymphatic practitioner while the patient drainage, and cerebrospinal remains passive or relaxed. fluid. The techniques used in this model are osteopathic –physiologic motion. Changes cranial manipulative medicine, in position of body structures ligamentous articular strain, within the normal range. See myofascial release, and also physiologic motion of the lymphatic pump techniques. spine. –structural model. The goal MFR. See osteopathic of the structural model is manipulative treatment, biomechanical adjustment and myofascial release. the mobilization of joints. This muscle energy technique. See model also seeks to address osteopathic manipulative problems in the myofascial treatment, muscle energy. connective tissues, as well as in the bony and soft tissues, myofascial release technique. to remove restrictive forces See osteopathic manipulative and enhance motion. This is treatment, myofascial release. accomplished by the use of myofascial technique. See a wide range of osteopathic osteopathic manipulative manipulative techniques treatment, myofascial release, such as high velocity low myofascial technique. amplitude, muscle energy, counterstrain, myofascial myofascial trigger point. See release, ligamentous articular trigger point, myofascial. techniques, and functional myogenic tonus. (1) Tonic techniques. contraction of muscle dependent motion. (1) A change of position on some property of the muscle (rotation and/or translation) with itself or of its intrinsic nerve respect to a fixed system. (2) An cells. (2) Contraction of a muscle act or process of a body changing caused by intrinsic properties position in terms of direction, of the muscle or by its intrinsic course, and velocity. innervation (Stedman’s).

Glossary of Osteopathic Terminology, 2017 31 myotome myotome. (1) All muscles derived NMM. See Neuromusculoskeletal from one somite and innervated Medicine. See also Osteopathic by one segmental spinal nerve. Neuromusculoskeletal Medicine. (Stedman’s) (2) That part of the NMM-OMM. somite that develops into skeletal Neuromusculoskeletal Medicine- muscle. Osteopathic Manipulative Medicine. See Osteopathic Neuromusculoskeletal Medicine. N non-neutral. The range of sagittal plane spinal positioning in Neuromusculoskeletal Medicine which the second principle of (NMM). The specialty within physiologic motion of the spine osteopathic medicine that applies. See also extension. See emphasizes the incorporation also flexion. See also physiologic of osteopathic manual motion of the spine. diagnosis and osteopathic manipulative treatment into non-allopathic lesion. Historic the evaluation and treatment term used to describe somatic of the nervous, muscular, dysfunction. See somatic and skeletal systems in their dysfunction. relationships to other systems of the body as well as the whole person. See also Certification in Neuromusculoskeletal Medicine. See also Osteopathic Neuromusculoskeletal Medicine (ONMM). neurotrophicity. See neurotrophy. neurotrophy. The nutrition and maintenance of tissues as regulated by direct innervation. neutral. (1) The range of sagittal plane spinal positioning in which the first principle of physiologic motion of the spine applies. (2) A point of tissue or articular balance from which all motions physiologic to that structure may take place. See also physiologic motion of the spine. (Fig. 23)

32 American Association of Colleges of Osteopathic Medicine osteopathic manipulative therapy (OMTh) normalization. The therapeutic OPP. Osteopathic principles and use of anatomic and physiologic practice. See also osteopathic mechanisms to facilitate the body’s philosophy. response toward homeostasis os coxa. See innominate. and improved health. osteopath. (1) A person who NSR. A descriptor of spinal has achieved the nationally somatic dysfunction used to recognized academic and denote a combination neutral professional standards within her (N), sidebent (S), and rotated or his country to independently (R) vertebral position; similar practice diagnosis and treatment descriptors may involve flexed based upon the principles (F) and extended (E) position. of osteopathic philosophy. nutation. Nodding forward; Individual countries establish anterior movement of the sacral the national academic and base around a transverse axis in professional standards for relation to the ilia. osteopaths practicing within their countries (international usage). (2) Considered by the American O Osteopathic Association (AOA) to be an historic term when applied oblique axis. See sacral motion to graduates of U.S. schools. See axis, oblique axis (diagonal). also DO. OCMM. See osteopathic osteopathic lesion (complex). manipulative treatment, Also called non-allopathic lesion. osteopathic cranial manipulative Historic term used to describe medicine. somatic dysfunction. See somatic dysfunction. OMM. See osteopathic manipulative medicine. osteopathic manipulative medicine (OMM). The application OMT. See osteopathic of osteopathic philosophy, manipulative treatment. structural diagnosis and use OMTh. See osteopathic of osteopathic manipulative manipulative therapy. treatment (OMT) in the diagnosis and management of the patient. ONMM. See Osteopathic See also osteopathic manipulative Neuromusculoskeletal Medicine. treatment (OMT). OP&P. Historic term for osteopathic manipulative osteopathic principles and therapy (OMTh). The therapeutic practice. See also osteopathic application of manually philosophy. guided forces by an osteopath

Glossary of Osteopathic Terminology, 2017 33 osteopathic manipulative treatment (OMT)

(non-physician) to improve the placement of the affected physiological function and ligaments in a position of equal homeostasis that has been tension in all appropriate altered by somatic dysfunction. planes so that the body’s inherent forces can resolve the osteopathic manipulative somatic dysfunction. See also treatment (OMT). The therapeutic ligamentous articular strain. application of manually guided See also balanced ligamentous forces by an osteopathic tension (BLT). physician (U.S. usage) to improve physiologic function and/or –balanced membranous tension support homeostasis that has been (BMT). Any OCMM method altered by somatic dysfunction. in which the goal of treatment is to achieve a state in which –active method. Any technique the affected craniosacral in which the patient voluntarily structures are equalized in all performs an osteopathic appropriate planes. See also practitioner-directed motion. balanced membranous tension –articulatory treatment. (BMT). See also osteopathic Historic term. See osteopathic cranial manipulative medicine manipulative treatment, (OCMM). articulatory. –Chapman reflex treatment. A –articulatory. A direct treatment method in which treatment method employing either classic rotatory motion a low velocity/moderate to or other methods used to high amplitude force applied address soft tissue dysfunction to a dysfunctional joint. The are applied to Chapman reflex osteopathic practitioner can points. See Chapman reflex. choose to employ a repetitive –combined treatment method. springing motion or a single (1) A treatment strategy where movement of the joint through the initial movements are the restrictive barrier. indirect; as the technique is –balanced ligamentous completed the movements tension (BLT). A treatment change to direct forces. (2) method that is a regional A manipulative sequence interpretation based on the involving two or more different article “Osteopathic Technique osteopathic manipulative of William G. Sutherland,” treatment method (e.g., published in the 1949 Year Spencer technique combined Book of Academy of Applied with muscle energy technique). Osteopathy. The method (3) A concept described by Paul involves the minimization of Kimberly, DO. peri-articular tissue load and

34 American Association of Colleges of Osteopathic Medicine osteopathic manipulative treatment (OMT)/facilitated oscillatory release (FOR)

–combined treatment. Historic manipulative medicine term. See osteopathic (OCMM). manipulative treatment, –Dalrymple technique. See combined treatment method. also osteopathic manipulative –compression of the fourth treatment, pedal pump. ventricle (CV-4). A cranial –direct method (technique). technique in which the lateral An osteopathic treatment in angles of the occipital squama which the restrictive barrier is are manually approximated engaged and a final activating slightly exaggerating the force is applied to correct posterior convexity of the somatic dysfunction. occiput and taking the cranium into sustained –exaggeration. An osteopathic extension. See also osteopathic treatment method in which cranial manipulative medicine the body part is moved slightly (OCMM). farther toward the direction of dysfunction so that the body’s –counterstrain (CS). (1) inherent forces can correct the An osteopathic method somatic dysfunction. of diagnosis and indirect treatment in which the –exaggeration technique. An patient’s somatic dysfunction, indirect procedure that involves diagnosed by an associated carrying the dysfunctional myofascial tender point, is part away from the restrictive treated by using a position barrier, then applying a high of spontaneous tissue velocity low amplitude force in release while simultaneously the same direction. monitoring the tender point. –facilitated oscillatory release (2) Developed by Lawrence (FOR). (1) A treatment method Jones, DO, FAAO, in 1955 intended to normalize (originally “spontaneous neuromuscular function by release by positioning”, it applying a manual oscillatory was later termed “strain- force, which may be combined counterstrain”. with any other ligamentous –cranial treatment (CR). or myofascial technique. (2) A See osteopathic cranial refinement of a long-standing manipulative medicine use of oscillatory force in (OCMM). See also primary osteopathic diagnosis and respiratory mechanism. treatment as published in early osteopathic literature. –CV-4. See compression of (3) A technique developed the fourth ventricle. See by Zachary Comeaux, DO as also osteopathic cranial an extension of his work with Robert Fulford, DO.

Glossary of Osteopathic Terminology, 2017 35 osteopathic manipulative treatment (OMT)/facilitated positional release (FPR)

–facilitated positional release the liver and enhancing bile (FPR). (1) A treatment method and lymphatic drainage from in which a dysfunctional the liver. body region is addressed –high velocity low amplitude with a combination of neutral (HVLA). Also called thrust positioning, application of an treatment method. An activating force (compression, osteopathic method in torsion, or distraction), and which the restrictive barrier placement into position of ease. is engaged in one or more (2) A technique developed by planes of motion and then Stanley Schiowitz, DO. a rapid, therapeutic force of –fascial release treatment. brief duration traveling a short See osteopathic manipulative distance is applied within the treatment, myofascial release. anatomic range of motion. –fascial unwinding. A –Hoover technique. (1) A form treatment method in which of functional method. (2) the osteopathic practitioner Developed by H.V. Hoover, moves the dysfunctional DO. See also osteopathic fascial tissues in response to a manipulative treatment, sensation of ease and bind in a functional method. dynamic continuous process. –indirect method (I/IND). –functional method. An A manipulative treatment indirect treatment utilizing in which the restrictive passive regional motion barrier is disengaged and input in multiple directions the dysfunctional body part to encourage optimal ease of is moved away from the the somatic dysfunction. The restrictive barrier. osteopathic practitioner guides –inhibitory pressure. A the manipulative procedure treatment method in which while the dysfunctional area steady pressure is applied to is being monitored in order to soft tissues to reduce reflex obtain a continuous feedback of activity and promote tissue the neurophysiologic response relaxation. to increased ease of motion. –integrated –Galbreath technique. See neuromusculoskeletal release osteopathic manipulative (INR). A treatment method in treatment, mandibular drainage. which indirect, direct, and/or –hepatic pump technique. release enhancing maneuvers Rhythmic compression applied are applied to reflexively over the liver for purposes of influence the biomechanics increasing blood flow through of the musculoskeletal system

36 American Association of Colleges of Osteopathic Medicine osteopathic manipulative treatment (OMT)/muscle energy and respective peripheral the name originally given to and central neural control the thoracic pump technique mechanisms. before the more extensive –Jones technique. See physiologic effects of the osteopathic manipulative technique were recognized. treatment, counterstrain. (2) A term coined by C. Earl Miller, DO. See osteopathic –ligamentous articular strain manipulative treatment, (LAS). (1) A treatment method thoracic pump technique. based on a geographical interpretation of the article –mandibular drainage “Osteopathic Technique technique. Soft tissue of William G. Sutherland,” manipulative technique published in the 1949 Year using passively induced jaw Book of Academy of Applied motion to improve drainage Osteopathy. The method of middle ear structures via involves disengagement, the eustachian tube and exaggeration and taking lymphatics. A technique first the dysfunctional opposing described by William Otis ligaments to a point of balance. Galbreath, DO. (2) A set of myofascial release –mesenteric release technique techniques described by (mesenteric lift). A technique Howard Lippincott, DO, and in which the double layer of Rebecca Lippincott, DO. peritoneum that invests the (3) Title of reference work intestines and its associated by Conrad Speece, DO, and vascular, neural and lymphatic William Thomas Crow, DO. structures is relieved of tension See also balanced ligamentous from the attachments to the tension. posterior wall of the abdomen –liver pump. See osteopathic which include the root of the manipulative treatment, mesentery, hepatic and splenic hepatic pump technique. flexures and ascending and descending colon. –lymphatic technique. A diverse group of techniques designed –muscle energy. (1) A direct to remove impediments to treatment method which lymphatic circulation and the patient’s muscles are promote and augment the flow employed upon request, from of interstitial fluid and lymph. a precisely controlled position, in a specific direction, and –lymphatic pump. (1) A term against a distinctly executed used to describe the impact of physician counterforce. (2) intrathoracic pressure changes First described in 1948 by Fred on lymphatic flow. This was Mitchell, Sr, DO.

Glossary of Osteopathic Terminology, 2017 37 osteopathic manipulative treatment (OMT)/myofascial release (MFR)

–myofascial release (MFR). practitioner using the primary A treatment method first respiratory mechanism and described by Andrew Taylor balanced membranous Still, MD, DO, and his early tension. See also primary students, which utilizes respiratory mechanism. See continual palpatory feedback to also balanced membranous alleviate restriction of the somatic tension. See also osteopathy in dysfunction and its related the cranial field (OCF). fascia and musculature. See –passive method. Any also direct myofascial release; technique in which the patient indirect myofascial release. is instructed to refrain from –direct myofascial release. voluntary muscle contraction. The dysfunctional myofascial –pedal pump. Also called the tissues are loaded and pedal fascial pump; Dalrymple restrictive barrier is engaged treatment. A venous and with a constant force. lymphatic drainage technique –indirect myofascial release. applied through the lower The dysfunctional myofascial extremities. tissues are loaded and then –percussion vibrator method. (1) guided towards the position of A treatment method involving greatest ease. the specific application of –myofascial technique. Any mechanical vibratory force to technique directed at the treat somatic dysfunction. (2) muscles and fascia. See also An osteopathic manipulative osteopathic manipulative technique developed by treatment, myofascial Robert Fulford, DO. release. See also osteopathic –progressive inhibition of manipulative treatment, soft neuromuscular structures tissue method. (PINS). (1) A method of –osteopathy in the cranial field diagnosis and treatment (OCF). Historic term. (1) Refers in which the osteopathic to the system of diagnosis practitioner localizes sensitive and treatment first described points and sequentially by William G. Sutherland, applies inhibitory pressure DO. (2) Title of reference along a predictable pathway work by Harold Magoun, Sr, to this series of related points. DO. See Osteopathic Cranial (2) Developed by Dennis Manipulative Medicine. Dowling, DO. –osteopathic cranial –soft tissue method (ST). A manipulative medicine (OCMM). group of direct techniques A system of diagnosis and that usually involve lateral treatment by an osteopathic stretching, linear stretching,

38 American Association of Colleges of Osteopathic Medicine osteopathic manipulative treatment (OMT)/visceral technique (VIS) deep pressure, traction and/ dysfunctional region is first or separation of muscle origin placed in an indirect position, and insertion while monitoring an axial force (compression, tissue response and motion traction, torsion) is added and changes by palpation. then used to carry the region Historically considered a form directly past neutral toward or of myofascial treatment. through its restrictive barrier. –Spencer technique. A (2) Attributed to Andrew series of direct manipulative Taylor Still, MD, DO. (3) Title of procedures to prevent or reference work by Richard Van decrease soft tissue and Buskirk, DO, PhD, FAAO. articular motion restrictions –thoracic pump technique. about the shoulder. See also (1) A technique that consists osteopathic manipulative of intermittent compression treatment, articulatory of the thoracic cage. (2) treatment (ART). Developed by C. Earl Miller, DO. –splenic pump technique. –thrust technique. See Rhythmic compression applied osteopathic manipulative over the spleen for the purpose treatment, high velocity low of enhancing the patient’s amplitude technique (HVLA). immune response. See also –traction technique. A osteopathic manipulative procedure in which the parts treatment, lymphatic pump. are stretched or separated –spontaneous release by along a longitudinal axis with positioning. See osteopathic continuous or intermittent manipulative treatment, force. counterstrain. –v-spread. Technique using –springing. A low velocity/ forces transmitted across the moderate to high amplitude diameter of the cranium to activating force using pressure improve sutural motion. and motion applied repeatedly –ventral technique. See against the restrictive barrier of osteopathic manipulative a dysfunctional structure. See treatment, visceral also osteopathic manipulative manipulation. treatment, articulatory –visceral manipulation (VIS). –strain counterstain. See Historically called ventral osteopathic manipulative techniques. A method of treatment, counterstrain. diagnosis and treatment –Still technique. (1) A directed to the viscera and/or combined manipulative the supportive structures to method utilizing both indirect improve physiologic function. and direct components. The

Glossary of Osteopathic Terminology, 2017 39 osteopathic manipulative treatment method osteopathic manipulative a primary residency disciplined treatment method. A group of in the neuromusculoskeletal techniques that apply to a set of system, its comprehensive distinct unifying principles that relationship to other organ guide individualized treatment. systems, and its dynamic function of locomotion. The osteopathic manipulative principle focus of the discipline treatment technique. A specific is osteopathic and patient- therapeutic manual procedure, centered; specifically, it embodies e.g. Dalrymple pedal pump, structural and functional Galbreath mandibular drainage, interrelation, body unity, self- pectoral traction, CV-4. healing, and self-maintenance. osteopathic medicine. The See also Certification in preferred term for a complete Neuromusculoskeletal Medicine system of medical care practiced and Osteopathic Manipulative by physicians with an unlimited Medicine (C-NMM/OMM). license that is represented by a See also Neuromusculoskeletal philosophy that combines the Medicine (NMM). needs of the patient with the osteopathic philosophy. A concept current practice of medicine, of health care supported by surgery and obstetrics. expanding scientific knowledge Emphasizes the interrelationship that embraces the concept of between structure and function, the unity of the living organism’s and has an appreciation of the structure (anatomy) and function body’s ability to heal itself. (physiology). Emphasizes the osteopathic musculoskeletal following principles. (1) The evaluation. The osteopathic human being is a dynamic unit of musculoskeletal evaluation function; (2) The body possesses provides information regarding self-regulatory mechanisms the health of the patient. Utilizing that are self-healing in nature; the concepts of body unity, (3) Structure and function are self-regulation and structure- interrelated at all levels; (4) function interrelationships, Rational treatment is based on the osteopathic physician uses these principles. data from the musculoskeletal osteopathic physician. A person evaluation to assess the patient’s with full unlimited medical status and develop a treatment practice rights who has achieved plan. (AOA House of Delegates.) the nationally recognized Osteopathic Neuromusculoskeletal academic and professional Medicine (ONMM). The standards within his or her osteopathic neuromusculoskeletal country to practice diagnosis medicine residency program is and treatment based upon

40 American Association of Colleges of Osteopathic Medicine patient cooperation the principles of osteopathic of the structural examination, philosophy. Individual countries osteopathic practitioner guide the establish the national academic osteopathic practitioner to the and professional standards for appropriate choice of treatment. osteopathic physicians practicing osteopathic tenets. within their countries. See osteopathic philosophy. osteopathic postural examination. osteopathy. Historic term. No The part of the osteopathic longer a preferred term in the structural examination that United States. See osteopathic focuses on the static and dynamic medicine. responses of the body to gravity while in the erect position. osteopathic practitioner. Refers P to an osteopath, an osteopathic physician or an allopathic palpation. The application of physician who has been trained the fingers to the surface of in osteopathic principles, the skin or other tissues, using practices and philosophy. varying amounts of pressure, osteopathic principles. See to selectively determine the osteopathic philosophy. condition of the parts beneath. osteopathic principles and palpatory diagnosis. A term used practices (OPP). See osteopathic by osteopathic practitioners to philosophy denote the process of palpating the patient to evaluate the osteopathic structural structure and function of the examination. The examination neuromusculoskeletal and of a patient by an osteopathic visceral systems. practitioner with emphasis on the neuromusculoskeletal palpatory skills. Sensory skills system as it reflects and interacts used in performing palpatory with other body systems in the diagnosis and osteopathic context of total patient care. manipulative treatment. This is accomplished primarily passive method. See osteopathic via inspection, motion testing, manipulative treatment, passive and palpation with the goal of method. determining the cause of the patient’s complaint and any passive motion. See motion, somatic dysfunction that may passive motion. be associated with it. Using the patient cooperation. Voluntary concepts of body unity, self- movement by the patient (on regulation and structure-function instruction from the osteopathic interrelationships; the findings

Glossary of Osteopathic Terminology, 2017 41 pedal pump practitioner) to assist in the palpatory diagnosis and treatment process. pedal pump. See osteopathic manipulative treatment, pedal pump. pelvic bone. See innominate. pelvic declination (pelvic unleveling). Pelvic rotation about an anterior-posterior (A-P) axis. pelvic girdle dysfunction. See somatic dysfunction, pelvic. pelvic index (PI). Represents a ratio of the measurements determined from postural radiograph. One (y) beginning from a vertical line originating at the sacral promontory to the intersection with the horizontal line from the anterior-superior position of the pubic bone. The involving the sacrum and second measurement (x) is along innominate. See somatic this same horizontal line. Normal dysfunction. See somatic values are age-related and increase dysfunction, innominate. in subjects with sagittal plane postural decompensation. Pelvic pelvic tilt. Pelvic rotation about index (PI) equals x/y. (Fig. 24) a transverse (horizontal) axis (forward or backward tilt) or pelvic rotation. Movement of about an anterior-posterior axis the entire pelvis in a relatively (right or left side tilt). horizontal plane about a vertical (longitudinal) axis. pelvis. Within the context of structural diagnosis, the pelvis pelvic sideshift. Deviation of the is made up of the right and left pelvis to the right or left of the innominates, (hip bones or os central vertical axis as translation coxae) the sacrum and coccyx. occurs along the horizontal (z) axis. Usually observed in the percussion vibrator technique. standing position. See osteopathic manipulative treatment, percussion vibrator pelvic somatic dysfunctions. A technique. group of somatic dysfunctions

42 American Association of Colleges of Osteopathic Medicine physiologic motion of the spine pétrissage. Deep kneading or a group of vertebrae are such squeezing action to express that sidebending and rotation swelling. occur in opposite directions (with rotation occurring physiologic barrier. See barrier, toward the convexity). (Fig. 25) physiologic barrier. See somatic dysfunction, type I physiologic motion. See motion, somatic dysfunction. physiologic motion. II. When the thoracic and physiologic motion of the spine. lumbar spine are sufficiently The three major principles of forward or backward bent physiologic motion are: (non-neutral), the coupled I. When the thoracic and motions of sidebending and lumbar spine are in a neutral rotation in a single vertebral position (easy normal), unit occur in the same the coupled motions of direction. (Fig. 26) See somatic sidebending and rotation for dysfunction, type II, somatic dysfunction.

Glossary of Osteopathic Terminology, 2017 43 plane

III. Initiating motion of a –coronal plane (frontal plane). vertebral segment in any plane A plane passing longitudinally of motion will modify the through the body from one movement of that segment in side to the other, and dividing other planes of motion. the body into anterior and Principles I and II of thoracic posterior portions. and lumbar spinal motion were –frontal plane. See plane, described by Harrison H. Fryette, coronal plane. DO (1918); Principle III was –horizontal plane. See plane, described by C.R. Nelson, DO transverse plane. (1948). See rotation. See also rotation of vertebra. –sagittal plane. A plane passing longitudinally through PINS. See progressive inhibition the body from front to back of neuromuscular structures and dividing it into right and (PINS). left portions. The median or plane. A flat surface determined midsagittal plane divides the by the position of three points body into approximately equal in space. Any of a number of right and left portions. imaginary surfaces passing –transverse plane (horizontal through the body and dividing it plane). A plane passing into segments. (Fig. 27) horizontally through the body –AP plane. See plane, sagittal perpendicular to the sagittal plane. and frontal planes, dividing the body into upper and lower portions. plastic deformation. A non-recoverable deformation. See also elastic deformation. plasticity. Ability to retain a shape attained by deformation. See also elasticity. See also viscosity. posterior component. A positional descriptor used to identify the side of reference when rotation of a vertebral segment has occurred. In a condition of right rotation, the right side is the posterior component. It usually refers to a prominent vertebral transverse process. See also anterior component.

44 American Association of Colleges of Osteopathic Medicine primary respiratory mechanism posterior nutation. See postural imbalance. A condition counternutation. in which ideal body mass distribution is not achieved. post-isometric relaxation. Immediately following an primary machinery of life. (1) The isometric contraction, the neuromusculoskeletal system. neuromuscular apparatus is in A term used to denote that body a refractory state during which parts act together to transmit and enhanced passive stretching may modify force and motion through be performed. The osteopathic which person acts out his or her practitioner may take up the life. This integration is achieved myofascial slack during the via the central nervous system relaxed refractory period. acting in response to continued sensory input from the internal postural axis. See sacral motion and external environment. (2) A axis, postural axis. term coined by I.M. Korr, PhD. postural balance. A condition primary respiratory mechanism. of optimal distribution of body mass in relation to gravity. (1) A conceptual model that describes a process involving postural decompensation. five interactives, involuntary Distribution of body mass functions. away from ideal when postural homeostatic mechanisms are 1. The inherent motility of the overwhelmed. It occurs in all brain and spinal cord. cardinal planes, but is classified 2. Fluctuation of the by the major plane(s) affected. cerebrospinal fluid. See plane. (Fig. 27) 3. Mobility of the intracranial and intraspinal membranes. –coronal plane postural decompensation. Causes 4. Articular mobility of the scoliotic changes. cranial bones. 5. Mobility of the sacrum –horizontal plane postural between the ilia decompensation. May cause (pelvic bones) that is postural changes where part interdependent with the or all of the body rotates motion at the sphenobasilar to the right or left. When synchondrosis. viewed from the right or left sides, alignment appears The mechanism refers to the asymmetrical. presumed inherent (primordial) driving mechanism of internal –sagittal plane postural respiration as opposed to decompensation. Causes the cycle of diaphragmatic kyphotic and/ or lordotic respiration (inhalation and changes. exhalation). It further refers to the

Glossary of Osteopathic Terminology, 2017 45 primary respiratory mechanism/primary innate interconnected movement progressive inhibition of of every tissue and structure neuromuscular structures (PINS). of the body. Optimal health See osteopathic manipulative promotes optimal function and treatment, progressive inhibition the inherent function of this of neuromuscular structures. interdependent movement can prolotherapy. See sclerotherapy. be negatively altered by trauma, disease states or other pathology. pronation. In relation to (2) This mechanism was the anatomical position, as first described by William G. applied to the hand, rotation Sutherland, DO, in 1939 in his of the forearm in such a way self-published volume, “The that the palmar surface turns Cranial Bowl.” The mechanism backward (internal rotation) in is thought to affect cellular relationship to the anatomical respiration and other body position. Applied to the foot. a processes. In the original combination of eversion and definition, the following abduction movements taking descriptions were given: place in the tarsal and metatarsal joints, resulting in lowering of –primary. Because it is directly the medial margin of the foot. See concerned with the internal also supination. tissue respiration of the central nervous system. prone. Lying face downward –respiratory. Because it further (Stedman’s). concerns the physiological psoas syndrome. A painful low function of the interchange of back condition characterized fluids necessary for normal by hypertonicity of psoas metabolism and biochemistry, musculature. The syndrome not only of the central nervous consists of a constellation of system, but also of all body cells. typically related signs and –mechanism. Because all the symptoms. constituent parts work together –typical associated somatic as a unit carrying out this dysfunctions. As a long restrictor fundamental physiology. See muscle, psoas hypertonicity also osteopathic manipulative is frequently associated with treatment; osteopathic cranial flexed dysfunctions of the upper manipulative medicine lumbars, extended dysfunction (OCMM). of L5, and variable sacral and prime mover. A muscle primarily innominate dysfunctions. responsible for causing a specific Tender points typically are joint action. found in the ipsilateral iliacus

46 American Association of Colleges of Osteopathic Medicine public compression

and contralateral piriformis –posterior pubic shear. A muscles. somatic dysfunction in which –typical gait. Trendelenburg one pubic bone is displaced gait. posteriorly as compared to the normal contralateral pubic –typical pain pattern. Low back bone. pain frequently accompanied by pain on the lateral aspect of –superior pubic shear. A the lower extremity extending somatic dysfunction in which no lower than the knee. one pubic bone is displaced superiorly as compared to the –typical posture. Flexion at the normal contralateral pubic hip and sidebending of the bone. (Fig. 29) lumbar spine to the side of the most hypertonic psoas muscle. pubic abduction. See pubic gapping. pubic bone, somatic dysfunctions of. pubic adduction. See pubic –anterior pubic shear. A compression. somatic dysfunction in which pubic compression. Also called one pubic bone is displaced pubic adduction. A somatic anteriorly as compared to the dysfunction in which the pubic normal contralateral pubic bones are forced toward each bone. other at the pubic symphysis. –inferior pubic shear. A This dysfunction is characterized somatic dysfunction in which by tenderness to palpation one pubic bone is displaced over the pubic symphysis, lack inferiorly as compared to the of apparent asymmetry, but normal contralateral pubic associated with restricted motion bone. (Fig. 28) of the pelvic ring. (Fig. 30)

Glossary of Osteopathic Terminology, 2017 47 pubic gapping pubic gapping. Also called pubic R abduction. A somatic dysfunction in which the pubic bones are reciprocal inhibition. The pulled away from each other inhibition of antagonist muscles at the pubic symphysis. This when the agonist is stimulated. dysfunction is frequently seen See also laws, Sherrington’s. in women following childbirth. (Fig. 31) reciprocal tension membrane. The intracranial and spinal dural pubic symphysis, somatic membrane including the falx dysfunctions of. See pubic bone, cerebri, falx cerebelli, tentorium, somatic dysfunctions of. and spinal dura. pump handle rib motion. See rib red reflex. See reflex, red. motion, pump handle motion. reflex. An involuntary nervous system response to a sensory input. The sum total of any particular involuntary activity. See also Chapman reflexes. –cephalogyric reflex. See reflex, oculocephalogyric. –cervicolumbar reflex. Automatic contraction of the lumbar paravertebral muscles in response to contraction of postural muscles in the neck. –conditioned reflex. One that does not occur naturally in the organism or system, but that is developed by regular association of some physiological function with a related outside event. –myotatic reflex.Tonic contraction of the muscles in response to a stretching force due to stimulation of muscle receptors (e.g., deep tendon reflex). –oculocephalogyric reflex. Also called oculogyric reflex; cephalogyric reflex. Automatic

48 American Association of Colleges of Osteopathic Medicine release

movement of the head natural, functional, or arbitrary that leads or accompanies boundaries. (2) Body areas for movement of the eyes. the diagnosis and coding of –oculogyric reflex. See somatic dysfunction as defined in oculocephalogyric reflex. the International Classification of Diseases (At time of print, ICD-10 –red reflex. (1) The CM) using the codes. See also erythematous biochemical transitional region. reaction (reactive hyperemia) of the skin in an area that has M99.00 Segmental and somatic been stimulated mechanically dysfunction of head region by friction. The reflex is greater M99.01 Segmental and somatic in degree and duration in dysfunction of cervical region an area of acute somatic M99.02 Segmental and somatic dysfunction as compared to dysfunction of thoracic region an area of chronic somatic M99.03 Segmental and somatic dysfunction. It is a reflection dysfunction of lumbar region of the segmentally related M99.04 Segmental and somatic sympathicotonia commonly dysfunction of sacral region observed in the paraspinal M99.05 Segmental and somatic area. (2) A red glow reflected dysfunction of pelvic region from the fundus of the eye when M99.06 Segmental and somatic a light is cast upon the retina. dysfunction of lower extremity M99.07 Segmental and somatic –somatosomatic reflex. dysfunction of upper extremity Localized somatic stimuli M99.08 Segmental and somatic producing patterns of reflex dysfunction of rib cage response in segmentally M99.09 Segmental and somatic related somatic structures. dysfunctions of abdomen and –somatovisceral reflex. other regions Localized somatic stimuli producing patterns of reflex regional extension. See extension, response in segmentally regional extension. related visceral structures. regional motor inputs. Motion –viscerosomatic reflex. initiated by an osteopathic Localized visceral stimuli practitioner through body contact producing patterns of reflex and vector input that produces a response in segmentally specific response at each segment related somatic structures. in the mobile system. regenerative injection therapy release. The palpable change (RIT). See sclerotherapy. towards normalization of abnormal tissue texture, joint region. (1) An anatomical division motion or inherent motion of the body defined either by

Glossary of Osteopathic Terminology, 2017 49 resilience perceived during or following –bucket handle motion. an osteopathic manipulative Movement of the ribs during treatment. respiration such that with inhalation, the lateral aspect resilience. Property of returning of the rib moves cephalad to the former shape or size after resulting in an increase of mechanical distortion. See also transverse diameter of the elasticity. See also plasticity. thorax. This type of rib motion respiratory axis of the sacrum. is predominantly found in See sacral motion axis, superior lower ribs, increasing in transverse axis. motion from the upper to the lower ribs (Fig. 33). See also respiratory cooperation. An rib motion, axis of. See also rib osteopathic practitioner-directed motion, pump handle. inhalation and/or exhalation by the patient to assist the –caliper rib motion. Motion of manipulative treatment process. ribs 11 and 12 characterized by single joint motion; analogous restriction. A resistance or to internal and external rotation. impediment to movement. –exhalation rib restriction. –joint restriction. This term Involves a rib or group of ribs is part of the TART acronym that first stops moving during for an osteopathic somatic exhalation. The key rib is the dysfunction. See barrier bottom rib in the group. See (motion barrier). See also TART. also rib somatic dysfunction, retrolisthesis. Posterior inhalation rib dysfunction. displacement of one vertebra relative to the one immediately below. rib lesion. Historic term. See rib somatic dysfunction, of. rib motion. –axis of rib motion. An imaginary line through the costotransverse and the costovertebral articulations of the rib. –anteroposterior rib axis. See also rib motion, bucket handle motion. (Fig. 32)

50 American Association of Colleges of Osteopathic Medicine rib, somatic dysfunction of

of the rib moves cephalad and causes an increase in the anteroposterior diameter of the thorax. This type of rib motion is found predominantly in the upper ribs, decreasing in motion from the upper to the lower ribs. (Fig. 34) See rib motion, axis of. See also rib motion, bucket handle motion. –transverse rib axis. See rib motion, pump handle rib motion inhalation. See also rib motion, inhalation rib restriction. See also rib motion, exhalation rib restriction. (Fig. 35)

–inhalation rib restriction. Involves a rib or group of ribs that first stops moving during inhalation. The key rib is the top rib in the group. See also rib somatic dysfunction, rib, somatic dysfunction of. A exhalation rib dysfunction. somatic dysfunction in which –pump handle motion. movement or position of one Movement of the ribs during or several ribs is altered or respiration such that with disrupted. For example, an inhalation the anterior aspect elevated rib is one held in a

Glossary of Osteopathic Terminology, 2017 51 rib somatic dysfunction, of/exhaled rib dysfunction position of inhalation such that cord-like feeling. See also tissue motion toward inhalation is freer, texture abnormality. and motion toward exhalation is rotation. Motion about an axis. restricted. A depressed rib is one held in a position of exhalation rotation dysfunction of the such that motion toward sacrum. Movement of the sacrum exhalation is freer and there is about a vertical (y axis) usually in a restriction in inhalation. See relation to the innominate bones. also rib motion, inhalation rib See sacrum, somatic dysfunctions restriction. See also rib motion, of, rotation of sacrum. exhalation rib restriction. rotation of vertebra. Movement –exhaled rib dysfunction. about the anatomical vertical axis (1) Somatic dysfunction (y axis) of a vertebra; named by characterized by a rib being the motion of a midpoint on the held in a position of exhalation anterior-superior surface of the such that motion toward vertebral body. (Fig. 36) exhalation is more free and motion toward inhalation is restricted. Synonyms. caught in exhalation, exhalation rib dysfunction, inhalation rib restriction, depressed rib. (2) An anterior rib tender point in counterstrain. See also rib motion, inhalation rib restriction. –inhaled rib dysfunction. A somatic dysfunction characterized by a rib being held in a position of inhalation such that motion toward inhalation is more free and motion toward exhalation is restricted. Synonyms. caught in inhalation, inhalation rib dysfunction, exhalation rib restriction, elevated rib. rule of threes. A method to locate the approximate position of RIT. See regenerative injection the transverse process (TP) of a therapy (RIT). See sclerotherapy.” thoracic segment by using the ropiness. A tissue texture location of the spinous process abnormality characterized by a (SP) of that same vertebra. The relationship is as follows:

52 American Association of Colleges of Osteopathic Medicine sacral movement axis/middle transverse axis (postural)

T1 to T3, TP is at the same level sacral movement axis. as tip of the SP. –anterior-posterior (A-P) (x) T4 to T6, TP is one half vertebral axis. Axis formed at the line of level above the tip of the SP. intersection of a sagittal and T7 to T9, TP is one full vertebral transverse plane. level above the tip of the SP. –inferior transverse axis T10, TP is one full vertebral (innominate). (1) The level above the tip of the SP. hypothetical functional axis of sacral motion that passes T11,.TP is one half vertebral from side to side on a line level above the tip of the SP. through the inferior auricular T12, TP is at the same level as surface of the sacrum and ilia, tip of the SP. and represents the axis for movement of the ilia on the sacrum. (2) A term described S by Fred Mitchell, Sr, DO. (Fig. 37) sacral base. (1) In osteopathic palpation, the uppermost posterior portion of the sacrum. (2) The most cephalad portion of the first sacral segment. sacral base anterior. See sacrum, somatic dysfunctions of, bilateral sacral flexion. sacral base declination (unleveling). With the patient in a standing or seated position, any deviation of the sacral base from the horizontal in a coronal plane. Generally, the rotation of –longitudinal axis. The the sacrum about an anterior- hypothetical axis formed at posterior (A-P) axis. the line of intersection of sacral base posterior. See sacrum, the midsagittal plane and somatic dysfunctions of, bilateral a coronal plane, See sacral sacral extension. motion axis, vertical (y) axis longitudinal. (Fig. 38) sacral base unleveling. See sacral –middle transverse axis base declination (unleveling). (postural). (1) The hypothetical sacralization. See transitional functional axis of sacral vertebrae, sacralization. nutation/counternutation in

Glossary of Osteopathic Terminology, 2017 53 sacral movement axis/oblique axis (diagonal)

the standing position, passing horizontally through the anterior aspect of the sacrum at the level of the second sacral segment. (2) A term described by Fred Mitchell, Sr., DO. (Fig. 37) –oblique axis (diagonal). (1) a hypothetical functional axis from the superior area of a sacroiliac articulation to the contralateral inferior sacroiliac articulation. It is designated as right or left relevant to its superior point of origin. (2) A term described by Fred Mitchell, Sr, DO. (Fig. 38) –transverse (z) axes. Axes –postural axis. See sacral formed by intersection of movement axis, middle the coronal and transverse transverse axis (postural). planes about which nutation/ (Fig. 37) counternutation occurs. (Fig. 37) –respiratory axis. See sacral movement axis, superior –vertical (y) axis (longitudinal). transverse axis (respiratory). The axis formed by the (Fig. 37) intersection of the sagittal and coronal planes. (Fig. 38) –superior transverse axis (respiratory). (1) The sacral somatic dysfunction. See hypothetical transverse axis sacrum, somatic dysfunctions of. about which the sacrum sacral sulcus. A depression just moves during the respiratory medial to the posterior superior cycle. It passes from side to iliac spine (PSIS) as a result of the side through the articular spatial relationship of the PSIS to processes posterior to the the dorsal aspect of the sacrum. point of attachment of the dura (Fig. 39, Fig. 40) at the level of the second sacral segment. Involuntary sacral sacral torsion. (1) A physiologic motion occurs as part of the function occurring in the craniosacral mechanism, and sacrum during ambulation and is believed to occur about this forward bending. (2) A sacral axis. (2) A term described by somatic dysfunction around an Fred Mitchell, Sr., DO. (Fig. 37, oblique axis in which a torque Fig. 38) occurs between the sacrum and

54 American Association of Colleges of Osteopathic Medicine sacrum,somatic dysfunction of/anterior sacrum innominates. The L5 vertebra rotates in the opposite direction of the sacrum. (3) If the L5 does not rotate opposite to the sacrum, L5 is termed maladapted. (4) Other terms for this maladaptation include, rotations about an oblique axis, anterior or posterior sacrum and a torsion with a non-compensated L5, an historic use. See also sacrum, somatic dysfunctions of. sacroiliac motion. Motion of the sacrum in relationship to the innominate(s) (ilium/ ilia). sacrum, inferior lateral angle (ILA) of. The point on the lateral surface of the sacrum where it curves medially to the body of the fifth sacral vertebrae. (Fig. 39, Fig. 40) sacrum, somatic dysfunctions of. See also somatic dysfunction of sacrum. –anterior sacrum. A positional term based on the Strachan model referring to sacral somatic dysfunction in which the sacral base has rotated anterior and sidebent to the side opposite the rotation. The upper limb (pole) of the SI joint has restricted motion and is named for the side on which forward rotation had occurred. Tissue texture changes are found at the deep sulcus. The motion characteristics of L5 are not described. (Fig. 41)

Glossary of Osteopathic Terminology, 2017 55 sacrum, somatic dysfunctions of/anterior translated sacrum

–backward torsions. Also called non-neutral sacral somatic dysfunctions, an historic use. (1) A backward sacral torsion is a physiologic rotation of the sacrum around an oblique axis such that the side of the sacral base contralateral to the named axis rotates posteriorly. L5 rotates in the direction opposite to the rotation of the sacral base. (2) A term by Fred Mitchell, Sr, DO, that describes the backward torsion as being non-physiologic in terms of the walking cycle. –bilateral sacral extension (sacral base posterior). (1) A sacral somatic dysfunction that involves rotation of the sacrum about a middle transverse axis such that the sacral base has moved posteriorly relative to the pelvic bones. Backward movement of the sacral base is freer, forward movement is restricted and both sulci are shallow. (2) The reverse of bilateral sacral flexion. (Fig 43) –bilateral sacral flexion (sacral base anterior). (1) A sacral somatic dysfunction that involves rotation of the sacrum about a middle transverse axis such that the sacral base has –anterior translated sacrum. A moved anteriorly between sacral somatic dysfunction in the pelvic bones. Forward which the entire sacrum has movement of the sacral base moved anteriorly (forward) is freer, backward movement between the ilia. Anterior is restricted and both sulci are motion is freer, and the deep. (2) The reverse of bilateral posterior motion is restricted. sacral extension. (Fig 44) (Fig. 42)

56 American Association of Colleges of Osteopathic Medicine sacrum torsions/left on right (backward) sacral torsion

the sacral base. (2) A group of somatic dysfunctions described by Fred Mitchell, Sr., DO, based on the motion cycle of walking. –left on left (forward) sacral torsion. Refers to left rotation torsion around a left oblique axis. (Fig. 45) See also sacral torsion.

–left on right (backward) sacral torsion. Refers to left rotation around a right oblique axis. –forward torsions. Also Findings. The left superior called neutral sacral somatic sacral sulcus is posterior or dysfunctions, a historic shallow, and the right ILA is term. (1) Forward torsion is anterior or deep. There is a a physiologic rotation of the positive seated flexion test sacrum around an oblique on the left. L5 is non-neutral axis such that the side of the SRRR. Left superior sacral sacral base contralateral to the sulcus will be restricted when named axis glides anteriorly springing. The lumbosacral and produces a deep sulcus. spring test is positive, and the L5 rotates in the direction sphinx test is positive. (Fig. 46) opposite to the rotation of See sacral torsion.

Glossary of Osteopathic Terminology, 2017 57 sacral torsions/posterior sacrum

–posterior sacrum. A positional term based on the Strachan model referring to a sacral somatic dysfunction in which the sacral base has rotated posterior and sidebent to the side opposite to the rotation. The dysfunction is named for the side on which the posterior rotation occurs. The tissue texture changes are found at the lower pole on the side of rotation. The motion characteristics of L5 are not described. (Fig. 47) –posterior translated sacrum. A sacral somatic dysfunction in which the entire sacrum has moved posteriorly (backward) The right superior sacral sulcus between the ilia. Posterior is posterior or shallow, and the motion is freer, and anterior left ILA is anterior or deep. The motion is restricted. (Fig. 49) seated flexion test is positive –right on left (backward) sacral on the right. L5 is non- neutral torsion. Refers to right rotation SLRL. The right superior sacral on a left oblique axis. Findings. sulcus is restricted when springing. The lumbosacral

58 American Association of Colleges of Osteopathic Medicine sacral torsions/sacral shear

slippage is equivalent to a unilateral sacral flexions and extensions. See also sacrum, somatic dysfunctions of, unilateral sacral flexion. See also sacrum, somatic dysfunctions of, unilateral sacral extension.

spring test is positive. The sphinx test is positive. (Fig. 48) See sacral torsion –right on right (forward) torsion. Refers to a right rotation about a right oblique axis. (Fig. 50) See sacral torsion. –rotated dysfunction of the sacrum. A sacral somatic dysfunction in which the sacrum has rotated about an axis approximating the longitudinal (y) axis. Motion is freer in the direction that rotation has occurred, and is restricted in the opposite direction. (Fig. 51) –sacral shear. A sacral somatic dysfunction in which the sacrum appears to have slipped anteriorly or posteriorly around a transverse axis allowing it to shift within the auricular L- or C-shaped sacroiliac joint. This anterior

Glossary of Osteopathic Terminology, 2017 59 sacral torsions/unilateral sacral extension

–unilateral sacral extension. by findings emerging from the (1) A sacral somatic initial examination. dysfunction in which the scaphocephaly. Also called dysfunctional side of the sacral scaphoid head or hatchet head. base is posterior (the sacral It is a transverse compression of sulcus of that side is shallow) the cranium with a resultant mid- in relation to the ilia and the sagittal ridge. ipsilateral ILA is anterior. (2) First described by Fred Mitchell, SR, DO. (Fig. 52)

–unilateral sacral flexion. (1) scaphoid head. See also A sacral somatic dysfunction scaphocephaly. in which the dysfunctional sclerotherapy. (1) Treatment sacral base is anterior (the involving injection of a sacral sulcus of that side is proliferant solution at the deep) in relation to the ilia and osseous-ligamentous junction. the ipsilateral ILA is posterior. (2) Treatment involving injection (2) First described by Fred of irritating substances into Mitchell, Sr., DO. (Fig. 53) weakened connective tissue sagittal plane. See plane, sagittal areas such as fascia, varicose plane. veins, hemorrhoids, esophageal varices, or weakened ligaments. SBS. See sphenobasilar The intended body’s response to synchondrosis. the irritant is fibrous proliferation scan. An intermediate detailed with shortening/ strengthening examination of specific body of the tissues injected. regions that have been identified

60 American Association of Colleges of Osteopathic Medicine screen sclerotome. (1) The pattern of sclerotomal pain. Deep, dull innervation of structures derived achy pain associated with from embryonal mesenchyme tissues derived from a common (joint capsule, ligament and sclerotome. (Fig. 54) bone). (2) The area of bone scoliosis. (1) Pathological or innervated by a single spinal functional lateral curvature of the segment. (3) The group of spine. (2) An appreciable lateral mesenchymal cells emerging deviation in the normally straight from the ventromedial part vertical line of the spine. (Fig. 55) of a mesodermal somite and migrating toward the notochord. screen. The initial general Sclerotomal cells from adjacent somatic examination to somites become merged in determine signs of somatic intersomatically located masses dysfunction in various regions of that are the primordia of the the body. See also scan. centra of the vertebrae. (Fig. 54)

Glossary of Osteopathic Terminology, 2017 61 secondary joint motion

segmental dysfunction. Dysfunction in a mobile system located at explicit segmental mobile units. Palpable characteristics of a dysfunctional segment are those associated with somatic dysfunction. Responses to regional motor inputs at the dysfunctional segment support the concepts of complete motor asymmetry and mirror-image motion asymmetries. See also STAR. See also TART. segmental mobile unit. A unit of the human movement system consisting of a bone, with articular surfaces for movement, as well as the adnexal tissues that create movement, allow secondary joint motion. Also movement and establish position called accessory joint motion. under motor control. Involuntary or passive motion of a joint. segmental motion. Movement within a vertebral unit described segment. (1) A portion of a larger by central nervous system (CNS) body or structure set off by response to repeated sensory natural or arbitrarily established stimulation that generally follows boundaries, often equated with habituation. spinal segment. (2) To describe a single vertebra or a vertebral sensitization. Hypothetically, a segment corresponding to short-lived (minutes or hours) the sites of origin of rootlets of increase in central nervous individual spinal nerves. (3) A system (CNS) response to portion of the spinal cord. repeated sensory stimulation that generally follows habituation. segmental diagnosis. The final stage of the spinal somatic shear. An action or force examination in which the nature causing or tending to cause of the somatic dysfunction is two contiguous parts of an detailed at a segmental level. See articulation to slide relative to also scan. See also screen. each other in a direction parallel to their plane of contact. See also pubic bone, somatic dysfunctions of. See also innominates,

62 American Association of Colleges of Osteopathic Medicine somatic dysfunction/chronic somatic dysfunction somatic dysfunctions of, somatic dysfunction. Impaired inferior innominate shear. or altered function of related See also innominates, somatic components of the body dysfunction of, superior framework system: skeletal, innominate shear. See also arthrodial and myofascial sacrum, somatic dysfunctions of, structures, and their related sacral shear. vascular, lymphatic and neural elements. It is characterized Sherrington law. See law, by positional asymmetry, Sherrington. restricted range of motion, tissue sidebent. The position of any one texture abnormalities, and/ or several vertebral bodies after or tenderness. The positional sidebending has occurred. and motion aspects of somatic (Fig. 56) See also sidebending. dysfunction are generally described by: (1) The position of a body part as determined by palpation and referenced to its defined adjacent structure, (2) The directions in which motion is freer, and (3) The directions in which motion is restricted. Somatic dysfunction is treatable using osteopathic manipulative treatment. –acute somatic dysfunction. Impairment or altered function sidebending. Also called lateral of related components of flexion, lateroflexion, or flexion the body framework system right (or left). Movement in a that is characterized in early coronal (frontal) plane about an stages by one or more of the anterior-posterior (x) axis. following: pain, erythema, skin drag. Sense of resistance to a palpable sense of relative light traction applied to the skin. warmth, moisture and Related to the degree of moisture bogginess, vasodilation, and degree of sympathetic edema, tenderness, and tissue nervous system activity. contraction. Identified by TART. See also TART. soft tissue (ST). See osteopathic manipulative treatment, soft –chronic somatic dysfunction. tissue method. Impairment or altered function of long standing duration soft tissue technique. See of related components of osteopathic manipulative the body framework system treatment, soft tissue method. characterized by one or more

Glossary of Osteopathic Terminology, 2017 63 somatic dysfunction of/pubic bone

of the following: itching, –sacral. A somatic dysfunction paresthesias, a palpable sense of the sacral region, sacroiliac of tissue dryness, coolness, joint and sacrococcygeal tissue contracture, fibrosis, region. tenderness and pallor. –thoracic. A somatic somatic dysfunction of. dysfunction of the thoracic region and thoracolumbar –pubic bone. See pubic bone, region. somatic dysfunctions of. –upper extremity. A somatic –pubic symphysis. See pubic dysfunction of upper extremity bone, somatic dysfunctions of. region, acromioclavicula. –sacrum. See sacrum, somatic –primary somatic dysfunction. dysfunctions of (1) The initial or first somatic –abdominal. A somatic dysfunction to appear dysfunction of abdomen and temporally. (2) The somatic other regions. dysfunction that maintains a –cranial. A somatic total pattern of dysfunction, dysfunction of the head and including other secondary. the occpito-atlantal region. –secondary somatic –cervical. A somatic dysfunction. (1) Somatic dysfunction of the cervical dysfunction arising in response region and the cervicothoracic from a primary somatic region. dysfunction. (2) Somatic –innominate. A somatic dysfunction arising as a dysfunction of lower. consequence of other etiology. –lower extremity. A somatic –type I somatic dysfunction. dysfunction of lower extremity A group dysfunction of the region. thoracic and lumbar vertebrae. These vertebrae are neutral –lumbar. A somatic dysfunction relative to the sagittal plane of the lumbar region and and demonstrate a preference lumbosacral region. for sidebending and rotation –pelvic. A somatic dysfunction in opposite directions, (e.g. of pelvic (iliosacral) region, sidebent right and rotated left or pubic region and hip region, sidebent left and rotated right). glenohumeral, sternoclavicular –type II somatic dysfunction. A and scapulothoracic region. single segmental dysfunction –rib. A somatic dysfunction of the thoracic or lumbar of rib cage, costochondral, vertebrae. This vertebra is costovertebral, sternal and significantly flexed or extended sternochondral regions. and demonstrates a preference

64 American Association of Colleges of Osteopathic Medicine sphenobasilar synchondrosis (SBS)/lateral strain

for sidebending and rotation in are held forced together the same direction (e.g. rotated significantly limiting SBS right and sidebent right or motion. sidebent left, rotated left). – SBS extension. Sphenoid somatogenic. That which is and occiput have rotated in produced by activity, reaction opposite directions around and change originating in the parallel transverse axes; the musculoskeletal system. basiocciput and basisphenoid are both inferior in SBS somatosomatic reflex. See reflex, extension with a decrease in somatosomatic reflex. the dorsal convexity between somatovisceral reflex. See reflex, these two bones. (Fig. 57) somatovisceral reflex. spasm. A sudden, violent, involuntary contraction of a muscle or group of muscles, attended by pain and interference with function, producing involuntary movement and distortion (compare with hypertonicity). (Dorland’s). Spencer technique. See osteopathic manipulative treatment, Spencer technique. sphenobasilar synchondrosis – SBS flexion. Sphenoid (SBS). Also called sphenobasilar and occiput have rotated in symphysis. The cartilaginous opposite directions around junction between the basilar parallel transverse axes; the portion of the sphenoid and the basiocciput and basisphenoid basilar portion of the occiput. are both superior in SBS –somatic dysfunctions of SBS. flexion with an increase in the Any of a group of somatic dorsal convexity between these dysfunctions involving two bones. (Fig. 58) primarily the inter-relationship –lateral strain. Sphenoid and between the basilar portion of occiput have rotated in the the sphenoid (basisphenoid) same direction around parallel and the basilar portion of the vertical axes. Lateral strains occiput (basiocciput). of the SBS are named for the – SBS compression. Somatic position of the basisphenoid, dysfunction in which the right or left. (Fig. 59) basisphenoid and basiocciput

Glossary of Osteopathic Terminology, 2017 65 sphenobasilar synchondrosis (SBS)/sidebending-rotation

sidebending-rotations are named for the convexity, right or left. (Fig. 60) –torsion. Sphenoid and occiput have rotated in opposite directions around an anterior- posterior (A-P) axis. SBS torsions are named for the high greater wing of the sphenoid, right or left. (Fig. 61)

–sidebending-rotation. Sphenoid and occiput have rotated in opposite directions around parallel vertical axes and rotate in the same direction around an anterior- posterior (A-P) axis. SBS

66 American Association of Colleges of Osteopathic Medicine spring test

the affected neurons themselves or their chemical environment. Once established, facilitation can be sustained by normal central nervous system (CNS) activity. splenic pump technique. See osteopathic manipulative treatment, splenic pump technique. spontaneous release by positioning. See osteopathic manipulative treatment, counterstrain. –vertical strain. Sphenoid and occiput have rotated in the sprain. Stretching injuries of same direction around parallel ligamentous tissue (compare transverse axes. Vertical strains with strain). of the SBS are named for the –first degree. Microtrauma. position of the basisphenoid, –second degree. Partial tear. superior or inferior. (Fig. 62) –third degree. Complete sphenobasilar symphysis (SBS). disruption. See sphenobasilar synchondrosis springing technique. See spinal facilitation. (1) The osteopathic manipulative maintenance of a pool of neurons treatment, springing technique; (e.g., premotor neurons, motor osteopathic manipulative neurons or preganglionic treatment, articulatory. sympathetic neurons in one or more segments of the spinal sphinx test. See backward cord) in a state of partial or bending test. subthreshold excitation; in this spring test. (1) A test used to state, less afferent stimulation is differentiate between backward required to trigger the discharge or forward sacral torsions/ of impulses. (2) A theory rotations. (2) A test used to regarding the neurophysiological differentiate bilateral sacral mechanisms underlying the extension and bilateral sacral neuronal activity associated flexion. (3) A test used to with somatic dysfunction. differentiate unilateral sacral (3) Facilitation may be due to extension and unilateral sacral sustained increase in afferent flexion.See also lumbosacral input, aberrant patterns of afferent input, or changes within

Glossary of Osteopathic Terminology, 2017 67 STAR spring test. Strachan model. See sacrum, somatic dysfunctions of, anterior STAR. A mnemonic for four sacrum. See also sacrum, somatic diagnostic criteria of somatic dysfunctions of, posterior sacrum. dysfunction: sensitivity changes, tissue texture abnormality, stretching. Separation of the asymmetry and alteration of the origin and insertion of a muscle quality and quantity of range and/or attachments of fascia of motion. and ligaments. static contraction. See contraction, stringiness. A palpable isometric contraction. tissue texture abnormality characterized by fine or string Still, MD, DO, Andrew Taylor. like myofascial structures. Founder of osteopathic medicine; 1828-1917. First announced the structural examination. tenets of osteopathic medicine See osteopathic structural on June 22, 1874, established the examination. American School of Osteopathy subluxation. (1) A partial or in 1892 at Kirksville, MO. incomplete dislocation. (2) A still point. (1) A term used term describing an abnormal to identify and describe the anatomical position of a joint temporary cessation of the which exceeds the normal rhythmic motion of the primary physiologic limit, but does not respiratory mechanism. It exceed the joint’s anatomical may occur during osteopathic limit. manipulative treatment when a superior (upslipped) innominate. point of balanced membranous See innominate, somatic or ligamentous tension is dysfunctions of, superior achieved. (2) A term used by innominate shear. William G. Sutherland, DO. superior pubic shear. See pubic Still Technique. See osteopathic bone, somatic dysfunctions of. manipulative treatment, Still See also symphyseal shear. Technique. (Fig. 31) strain. (1) Stretching injuries of superior transverse axis. See muscle tissue. (2) Distortion with sacral motion axis, superior deformation of tissue. See also transverse axis (respiratory); ligamentous strain. sacral motion axis, transverse strain-counterstrain. See (z) axis. osteopathic manipulative supination. (1) Beginning in treatment, counterstrain. anatomical position, applied to the hand, the act of turning

68 American Association of Colleges of Osteopathic Medicine tenderpoints the palm forward (anteriorly) T or upward, performed by lateral external rotation of the forearm. (2) Applied to the foot, it tapotement. Striking the belly of generally applies to movements a muscle with the hypothenar (adduction and inversion) edge of the open hand in rapid resulting in raising of the medial succession in an attempt to margin of the foot, hence of the increase its tone and arterial longitudinal arch. A compound perfusion. motion of plantar flexion, TART. A mnemonic for four adduction and inversion. diagnostic criteria of somatic See also pronation. dysfunction: tissue texture supine. Lying with the face abnormality, asymmetry, upward. restriction of motion, and tenderness. symmetry. The similar arrangement in form and technique. Methods, procedures, relationships of parts around a and details of a mechanical common axis, or on each side of process or surgical operation. See a plane of the body. also osteopathic manipulative treatment. Sutherland fulcrum. A shifting suspension fulcrum of the tenderness. (1) Discomfort or reciprocal tension membrane pain elicited by an osteopathic located along the straight sinus practitioner through palpation. at the junction of the falx cerebri (2) A state of heightened and tentorium cerebelli. See also sensitivity to touch or pressure. reciprocal tension membrane; tender points. Small, osteopathic manipulative hypersensitive points in the treatment, osteopathic cranial myofascial tissues of the body manipulative medicine (OCMM). that do not have a pattern of symphyseal shear. The result of an pain radiation. These points action or force causing or tending are a manifestation of somatic to cause the two parts of the dysfunction and are used as symphysis to slide relative to each diagnostic criteria and for other in a direction parallel to monitoring treatment. See also their plane of contact. It is usually tenderpoints. See also trigger found in an inferior/superior point. direction but is occasionally tenderpoints. A system of found to be in an anterior/ myofascial tender points used posterior direction. for the counterstrain system for (Fig. 28, Fig. 31) the diagnosis and treatment of somatic dysfunction originally

Glossary of Osteopathic Terminology, 2017 69 thoracic aperture (superior) described by Lawrence Jones, aids in the maintenance of DO, FAAO. See also osteopathic posture and facilitates a response manipulative treatment, to stimulation. counterstrain. torsion. A motion or state where thoracic aperture (superior). See one end of a part is twisted thoracic inlet. about a longitudinal axis while the opposite end is held fast or thoracic inlet. (1) The functional turned in the opposite direction. thoracic inlet consists of T1-4 vertebrae, ribs 1 and 2 plus torsion, sacral. See sacral torsion. their costal cartilages, and the See also sacrum, somatic manubrium of the sternum. (2) dysfunctions of. The anatomical thoracic inlet torsion, spehnobasilar consists of T1 vertebra, the first synchondrosis. A physiologic ribs and their costal cartilages, motion pattern about an and the superior end of the anteroposterior axis of the manubrium. See fascial patterns. sphenobasilar symphysis/ thoracic pump. See osteopathic synchondrosis. See also manipulative treatment, thoracic sphenobasilar synchondrosis pump technique. (SBS), torsion. thrust technique. See osteopathic traction. A linear force acting to manipulative treatment, thrust draw structures apart. technique. See also osteopathic traction technique. See manipulative treatment, high osteopathic manipulative velocity low amplitude technique treatment, traction technique. (HVLA). transitional region. Areas of the tissue texture abnormality (TTA). axial skeleton where structure A palpable change in the tissues changes significantly lead to of the body away from their functional changes; transitional normal state. Common findings areas commonly include the include: bogginess, thickness, following: ropiness, stringiness, firmness, and changes in temperature –occipitocervical region (OA). or moisture. This term is part Typically the OA-AA-C2 region of the “TART” acronym for the is described. diagnostic criteria of somatic –cervicothoracic region (CT). dysfunction. See also TART. Typically C7-T(1) tonus. A normal physiologic –thoracolumbar region (TL). state in which there is a slight Typically T10-L(1) continuous tension of muscle –lumbosacral region (LS). tissue, which in skeletal muscles, Typically L5-S(1)

70 American Association of Colleges of Osteopathic Medicine Traube-Herring-Mayer wave transitional vertebrae. A translatory motion. See motion, congenital anomaly of a translatory motion. vertebra in which it develops transverse axis of sacrum. See characteristic(s) of the adjoining sacral, sacral movement axis, structure or region. transverse (z) axis. (Fig. 37) –lumbarization. A transitional segment in which the first transverse process. Projects sacral segment becomes like laterally from the region of each an additional lumbar vertebra pedicle. The pedicle connects articulating with the second the posterior elements to the sacral segment. vertebral body. (Fig. 63) –sacralization. (1) Incomplete transverse rib axis. See also separation and differentiation rib motion, pump handle rib of the fifth lumbar vertebra motion. (Fig. 34) (L5) such that it takes on Traube-Herring-Mayer wave. characteristics of a sacral An oscillation that has been vertebra. (2) When transverse measured in association with processes of the fifth lumbar blood pressure, heart rate, cardiac (L5) are atypically large, contractility, pulmonary blood causing pseudoarthrosis flow, cerebral blood flow and with the sacrum and/or movement of the cerebrospinal ilia(um), referred to as batwing fluid, and peripheral blood flow deformity, if bilateral. including venous volume and translation. Motion along an axis. thermal regulation. This whole- body phenomenon, which

Glossary of Osteopathic Terminology, 2017 71 Travell trigger point exhibits a rate typically slightly trophic. Pertaining to nutrition, less than and independent of especially in the cellular respiration, bears a striking environment (e.g., trophic resemblance to the primary function — a nutritional respiratory mechanism. function). Travell trigger point. See trigger trophicity. (1) A nutritional point. function or relation. (2) The natural tendency to replenish treatment, active. A historical the body stores that have been term. See osteopathic depleted. manipulative treatment, active method. trophotropic. Concerned with or pertaining to the natural treatment, osteopathic tendency for maintenance and/or manipulative techniques. restoration of nutritional stores. See osteopathic manipulative treatment. tropic. A word termination denoting turning toward, Trendelenburg test. The patient, changing or tendency to change. with back to the examiner, is told to lift first one foot and tropism, facet. Unequal size and/ then the other. The position and or facing of the zygapophyseal movements of the gluteal fold joints of a vertebra. See also facet are watched. When standing on asymmetry. the affected limb the gluteal fold type I somatic dysfunction. See on the sound side falls instead somatic dysfunction, type I of rising. Seen in poliomyelitis, somatic dysfunction. See also un-united fracture of the femoral physiologic motion of the spine. neck, coxa vara and congenital dislocations. type II somatic dysfunction. See somatic dysfunction, type II trigger point (myofascial trigger somatic dysfunction. See also point). (1) A small hypersensitive physiologic motion of the spine. site that, when stimulated, consistently produces a reflex mechanism that gives rise to referred pain and/or other U manifestations in a consistent reference zone that is consistent uncommon compensatory pattern. from person to person. (2) These See fascial patterns, uncommon points were most extensively compensatory pattern. and systematically documented. uncompensated fascial by Janet Travell, MD, and David pattern. See fascial patterns, Simons, MD. uncompensated fascial pattern.

72 American Association of Colleges of Osteopathic Medicine weight-bearing line of L3

V visceral manipulation. See osteopathic manipulative v-spread. See osteopathic treatment, visceral manipulation. manipulative treatment, viscerosomatic dysfunction. v-spread. Somatic dysfunction related to a velocity. The instantaneous rate viscerosomatic reflex.See reflex, of motion in a given direction. viscerosomatic. ventral technique. See osteopathic viscerosomatic reflex. See reflex, manipulative treatment, visceral viscerosomatic reflex. manipulation. viscerovisceral reflex: See reflex, vertebral unit. Two adjacent viscerovisceral reflex. vertebrae with their associated viscosity. (1) A measurement of intervertebral disk, arthrodial, the rate of deformation of any ligamentous, muscular, vascular, material under load. (2) The lymphatic and neural elements. capability possessed by a solid of (Fig. 64) yielding continually under stress. See also elasticity; plasticity.

weight-bearing line of L3. See gravitational line. (Fig. 16)

vertical axis. See sacral motion axis, vertical (y) axis (longitudinal). visceral dysfunction. Impaired or altered mobility or motility of the visceral system and related fascial, neurological, vascular, skeletal and lymphatic elements.

Glossary of Osteopathic Terminology, 2017 73

Abbreviations

AA atlanto-axial AACOM American Association of Colleges of Osteopathic Medicine AOA American Osteopathic Association AOBNMM American Osteopathic Board of Neuromusculoskeletal Medicine A-P anterior-posterior ART articulatory AIIS anterior inferior iliac spines ASIS anterior superior iliac spines BLT balanced ligamentous tension BMT balanced membranous tension C-NMM/ Certification in Neuromusculoskeletal Medicine/ OMM Osteopathic Manipulative Medicine C cervical CCP common compensatory pattern CNS central nervous system CO coccygeal COCA Association Commission on Osteopathic College Accreditation CR cranial CRI cranial rhythmic impulse

Glossary of Osteopathic Terminology, 2017 75 Abbreviations

CS counterstrain treatment CT cervico-thoracic CV-4 compression of the 4th ventricle technique D direct treatment DIR direct treatment DO Doctor of Osteopathic Medicine or Diplomat in Osteopathy E extended ECOP Educational Council on Osteopathic Principles ERS extended/rotated/sidebent F flexed FAAO Fellow of the American Academy of Osteopathy FOR facilitated oscillatory release treatment FPR facilitated positional release treatment FRS flexed/rotated/sidebent HVLA high velocity low amplitude treatment I indirect treatment ILA inferior lateral angle IND indirect treatment I/IND indirect method INR integrated neuromusculoskeletal release treatment JTP Jones tenderpoint L left or lumbar LAS ligamentous articular strain treatment LS lumbo-sacral ME muscle energy treatment MFR myofascial release treatment MTrP myofascial trigger point N neutral

76 American Association of Colleges of Osteopathic Medicine Abbreviations

NMM-OMM neuromusculoskeletal medicine-osteopathic manipulative medicine NRS neutral/rotated/sidebent OA occipito-atlantal OCF osteopathy in the cranial field (historical) OCMM osteopathic cranial manipulative medicine OMM osteopathic manipulative medicine OMT osteopathic manipulative treatment OMTh osteopathic manipulative therapy ONMM osteopathic neuromusculoskeletal medicine OPP osteopathic principles and practice PINS progressive inhibition of neuromuscular structures PSIS posterior superior iliac spines R right or rotated or rib RIT regenerative injection therapy S sidebent or sacrum SBS sphenobasilar synchondrosis SD somatic dysfunction ST soft tissue STAR sensitivity / tissue texture changes/ asymmetry / restriction of motion T thoracic TART tenderness / asymmetry / restriction of motion / tissue texture change TL thoraco-lumbar TP tenderpoint TrP Travell trigger point TTA tissue texture abnormality VIS visceral manipulative treatment

Glossary of Osteopathic Terminology, 2017 77

key word

Dorland, W A Newman. Dorland’s illustrated medical dictionary. 31st ed. Philadelphia, PA : Saunders; 2007

About AACOM

Mission The American Association of Colleges of Osteopathic Medicine (AACOM) provides leadership for the osteopathic medical education community by promoting excellence in medical education, research and service, and by fostering innovation and quality across the continuum of osteopathic medical education to improve the health of the American public.

Vision AACOM is recognized as the international leader of osteopathic medical education (OME) and an international leader of medical education. Through the colleges of osteopathic medicine and its Councils, AACOM coordinates the role of OME in the U.S. health care system and promotes and fosters excellence throughout medical education. Osteopathic medical education develops physicians through a continuum of education that is based upon osteopathic philosophy and practice and the training of physicians who are highly qualified in the knowledge, skills, and temperament to lead and participate in the delivery of health care in the 21st Century. OME consists of knowledge-based learning communities that are innovative in their advanced use of technology for collaboration, communication and the delivery of outcome-based curriculum. AACOM supports the use of an open electronic forum for facilitating communication and knowledge management. By promoting community-oriented and learner-centered medical education, and a preventive medicine perspective, osteopathic medical education programs train physicians to provide high-quality health care to meet the public’s changing health care needs.

Glossary of Osteopathic Terminology, 2017 79 About AACOM

AACOM is positioned to assume a leadership role in promoting continuous quality improvement of osteopathic medical education. AACOM facilitates the development of medical educators and administrators. It is internationally recognized as a primary resource for innovative teaching techniques and methodologies; for advances in curriculum design and evaluation strategies; for enhanced teaching tools; and for highlighting best practices in the delivery of education in Osteopathic Principles and Practice. It promotes and facilitates clinical, basic science, health care services, and medical education research and its dissemination, promotes the training of researchers, and identifies sources of research and other grant and contract funding. AACOM sponsors internationally recognized meetings on osteopathic medical education and research. The AACOM office is the national leader in the processing of applications for colleges of osteopathic medicine, and in enhancing the OME applicant pool. AACOM maintains collaborative relationships with other organizations that serve a complementary purpose. AACOM is recognized as the primary source of useful data concerning OME and facilitates data-based decision making. It is the major resource of OME information and analysis for government policymakers and other entities, and an advocate on behalf of the colleges of osteopathic medicine.

5550 Friendship Blvd., Suite 310 Chevy Chase, MD 20815-7231 www.aacom.org

80 American Association of Colleges of Osteopathic Medicine