1. Indirect Techniques Review
OMS-I Fall
Indirect Techniques Review

3. Indirect Techniques…
A – Position towards the barrier into the direction of free motion
B – Position away from the barrier into the direction of free motion
C – Position towards the barrier into the direction of restriction
D – Position away from the barrier into the direction of restriction

4. Indirect Techniques…
A – Position towards the barrier into the direction of free motion
B – Position away from the barrier into the direction of free motion
C – Position towards the barrier into the direction of restriction
D – Position away from the barrier into the direction of restriction

5. What is FALSE about the relationship of fascia to somatic dysfunction?
A – Myofibroblastic activity is increased
B – Fibroblastic activity is decreased
C – Connective tissue production is increased
D – Connective tissue shrinks

6. What is FALSE about the relationship of fascia to somatic dysfunction?
A – Myofibroblastic activity is increased
B – Fibroblastic activity is decreased
C – Connective tissue production is increased
D – Connective tissue shrinks

7. What is FALSE about Indirect Myofascial Release?
A – May not work on subluxation or chronic fibrosis
B -- Dampens signals from Mechanoreceptors in fascia
C – Activates Nociceptive pathways
D – Improves local vascularity & interstitial circulation

8. What is FALSE about Indirect Myofascial Release?
A – May not work on subluxation or chronic fibrosis
B -- Dampens signals from Mechanoreceptors in fascia
C – Activates Nociceptive pathways
D – Improves local vascularity & interstitial circulation

9. What is FALSE about Strain-Counterstrain?
A – Places the patient in a position of maximum comfort/ease to arrest inappropriate proprioceptor activity that maintains the dysfunction
B – Was discovered by accident by Lawrence H. Jones, DO in the 1950s
C – A tenderpoint must be monitored continuously for appropriate treatment
D – Is heavily contraindicated in somatic dysfunctions involving pain or inflammation, especially in hospital Emergency Department settings

10. What is FALSE about Strain-Counterstrain?
A – Places the patient in a position of maximum comfort/ease to arrest inappropriate proprioceptor activity that maintains the dysfunction
B – Was discovered by accident by Lawrence H. Jones, DO in the 1950s
C – A tenderpoint must be monitored continuously for appropriate treatment
D – Is heavily contraindicated in somatic dysfunctions involving pain or inflammation, especially in hospital Emergency Department settings

11. What is the second phase of Counterstrain?
A – inflammatory chemical washout
B – turning off nociceptors
C – turning off proprioceptors
D – electrochemical (neural) resetting of resting muscle fiber length

12. What is the second phase of Counterstrain?
A – inflammatory chemical washout
B – turning off nociceptors
C – turning off proprioceptors
D – electrochemical (neural) resetting of resting muscle fiber length

13. Phases of Counterstrain
1 – Turning off nociceptive and proprioceptive protective reflexes
2 – Resetting muscle fiber length
3 – Inflammatory chemical washout

14. What is an Absolute Contraindication for using Strain-Counterstrain?
A – Vertebral Artery disease
B – Patient cannot voluntarily relax
C – Rheumatoid Arthritis or Down Syndrome
D – Patient states they do not want Counterstrain treatments

15. What is an Absolute Contraindication for using Strain-Counterstrain?
A – Vertebral Artery disease
B – Patient cannot voluntarily relax
C – Rheumatoid Arthritis or Down Syndrome
D – Patient states they do not want Counterstrain treatments

16. Counterstrain…
A – Involves passively stretching the muscles to be treated
B – Passively shortens the muscle being treated
C – Involves moving the patient gently through the barrier
D – Crashes through the patient’s anatomic barrier

17. Counterstrain…
A – Involves passively stretching the muscles to be treated
B – Passively shortens the muscle being treated
C – Involves moving the patient gently through the barrier
D – Crashes through the patient’s anatomic barrier

18. Your patient complains of tension headaches
Your patient complains of tension headaches. In your exam, you find a tenderpoint at the superior medial border of the scapula. The muscle is:
A – trapezius
B – rhomboids
C – levator scapulae
D – pec minor

19. Your patient complains of tension headaches
Your patient complains of tension headaches. In your exam, you find a tenderpoint at the superior medial border of the scapula. The muscle is:
A – trapezius
B – rhomboids
C – levator scapulae
D – pec minor

20. You obtain consent and decide to proceed with Counterstrain
You obtain consent and decide to proceed with Counterstrain. The appropriate technique is:
A – Patient is prone. Sidebend the head towards the TP, adduct & flex the shoulder, applying a cephalad force through the shaft of the humerus to elevate the scapula. Hold for 90 seconds, fine tune as needed.
B – Patient is supine. Sidebend the head towards the TP, adduct & flex the shoulder, applying a cephalad force through the shaft of the humerus to elevate the scapula. Hold for 90 seconds, fine tune as needed.
C – Patient is supine. Sidebend the head away from the TP, adduct & flex the shoulder, applying a compressive cephalad force through the humerus to elevate the scapula. Hold for 90 seconds.

21. You obtain consent and decide to proceed with Counterstrain
You obtain consent and decide to proceed with Counterstrain. The appropriate technique is:
A – Patient is prone. Sidebend the head towards the TP, adduct & flex the shoulder, applying a cephalad force through the shaft of the humerus to elevate the scapula. Hold for 90 seconds, fine tune as needed.
B – Patient is supine. Sidebend the head towards the TP, adduct & flex the shoulder, applying a cephalad force through the shaft of the humerus to elevate the scapula. Hold for 90 seconds, fine tune as needed.
C – Patient is supine. Sidebend the head away from the TP, adduct & flex the shoulder, applying a compressive cephalad force through the humerus to elevate the scapula. Hold for 90 seconds.

22. You go home for the holidays and find that your mom has a tenderpoint on her SCM. You offer your newly-formed OMM skills by:
A – flexing her head, SB towards, rotating away (F-STRA)
B – flexing her head, SB towards, rotating towards (F-STRT)
C – extending her head, SB away, rotating away (E-SARA)
D – extending her head, SB away, rotating towards (E-SART)

23. You go home for the holidays and find that your mom has a tenderpoint on her SCM. You offer your newly-formed OMM skills by:
A – flexing her head, SB towards, rotating away (F-STRA)
B – flexing her head, SB towards, rotating towards (F-STRT)
C – extending her head, SB away, rotating away (E-SARA)
D – extending her head, SB away, rotating towards (E-SART)

24. Counterstrain for a Pec Major tenderpoint is:
A – Patient seated, physician behind. Flex and adduct the shoulder until the humerus is at the same level as the TP. Internally rotate and adduct the humerus with traction.
B – Patient supine, physician opposite TP. Flex and adduct the shoulder until the humerus is at the same level as the TP. Internally rotate and adduct the humerus with traction.
C – Patient supine, physician opposite TP. Adduct the arm, grabbing the shoulder to shorten the muscle.
D – A & B

25. Counterstrain for a Pec Major tenderpoint is:
A – Patient seated, physician behind. Flex and adduct the shoulder until the humerus is at the same level as the TP. Internally rotate and adduct the humerus with traction.
B – Patient supine, physician opposite TP. Flex and adduct the shoulder until the humerus is at the same level as the TP. Internally rotate and adduct the humerus with traction.
C – Patient supine, physician opposite TP. Adduct the arm, grabbing the shoulder to shorten the muscle.
D – A & B

26. To treat a Trapezius tenderpoint on a supine patient, you would…
A – Monitor the TP, SB towards and rotate away (STRA) until you feel a softening at the TP and the patient’s pain is relieved. Then have the patient return their head to neutral and reassess, aiming for at least 70% improvement.
B – Same as A, but SB away and rotate away (SARA).
C – Same as A, but SB towards and rotate towards (STRT).
D – Same as A, but the physician should return the patient’s head to neutral.

27. To treat a Trapezius tenderpoint on a supine patient, you would…
A – Monitor the TP, SB towards and rotate away (STRA) until you feel a softening at the TP and the patient’s pain is relieved. Then have the patient return their head to neutral and reassess, aiming for at least 70% improvement.
B – Same as A, but SB away and rotate away (SARA).
C – Same as A, but SB towards and rotate towards (STRT).
D – Same as A, but the physician should return the patient’s head to neutral.

28. Reciprocal Inhibition is…
A – Activation of the agonist
B – Activation of the antagonist

29. Reciprocal inhibition, indirect (Savarese 135+)
By contracting the antagonistic muscle, signals are transmitted to the spinal cord and through the reciprocal inhibition reflex arc, the agonist muscle is then forced to relax.
If the biceps muscle is in spasm, fully flex the elbow (away from the restrictive barrier). Then have the patient contract his/her triceps against resistance. This isometric force through reciprocal inhibition allows the biceps muscle to relax and return to a normal resting state.

30. Neural Activity of Agonist & Antagonist in SD

31. Counterstrain works by…
A – reciprocal inhibition of antagonists
B – reciprocal inhibition of antagonists
C – reciprocal inhibition of antagonists
D – reciprocal inhibition of antagonists