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Feely's Abridged Osteopathic Dictionary

Richard A. Feely, D.O., FAAO, FCA, FAAMA

– A –

angle, lumbosacral: represents the angle of the lubosacral junction as measured by the inclination of the superior surface of the first sacral vertebra to the horizontal (this is actually a sacral angle); usually measured from standing lateral x-ray films; also known as Ferguson's angle.

articulation: 1. the place of union of junction between two or more bones of the skeleton; 2. the active or passive progress of moving a joint through its permitted anatomic range of motion.

assymmetry: absence of symmetry of position or motion; dissimilarity in corresponding parts of organs or opposite sides of the body which are normally alike; of particular use when describing position or motion alteration resulting from somatyc dysfunction.

axoplasmic transport: the antegrade movement of substance from the nerve cell along the axon toward the terminals, and the retrograde movement from the terminals toward the nerve cell.

– B –

barrier (motion barrier): the limit to motion; in defining barriers, the palpatory end-feel chracateristics are useful.

anatomic barrier: the limit of motion imposed by anatomic structure; the limit of passive motion.

elastic barrier: the range between the physiologic and antomic barrier of motion in which passive ligamentous stretching occurs before tissue disruption.

physiologic barrier: the limit of active motion; can be altered to increase range of active motion by warm-up activity.

restrictive barrier: a functional limit within the anatomic range of motion, which abnormallly diminishes the normal physiologic range.

pathologic barrier: 1. restrictive barrier; 2. permanent restriciton of joint motion associated with pathologic change of tissues (example: contracture, osteophytes).

bind: relative palpable resistance to motion of an articulation or tissue, Synonym: resistance; antonums: ease, compliance, resilience.

biomechanics: mechanical principles applied to the study of biological functions; the application of mechanical laws to living structures; the study and knowledge of biological function from an application of mechanical principles.

bogginess: a tissue texture abnormality characterized principally by a palpable sense of sponginess inthe tissue, interprted as resulting from congestion due to increased fluid content.

bucket handle rib motion: movement of the ribs during respiration such that with inhalation the lateral aspect of the rib moves cephaled resulting in an increase of transverse diameter of the thorax; this type of rib motion is predominately found in the lower ribs, increasing from the upper to the lower ribs.

– C –

caudad: toward the tail or inferiorly.

cephalad: toward the head.

cerebrospinal fluid, fluctuation of: a description of the hypothesized action of cerebrospinal fluid with regard to the cranioscral mechanism.

Chapman's reflex: a system of reflex points originally used by Frank Chapman, D.O.  that were described by Charles Owens, D.O. These reflexes present as predictable anterior and posterior fascial tissue texture abnormalities assumed to be reflections of visceral dysfunction or pathology (viscerosomatic reflexes). A given reflex is consistently associated with the same viscus. Chapman's reflexes are manifested by palpatory findings of plaque-like changes of stringiness of the involved tissues.

circumduction: the active or passive circular movement of a limb; the rotary movement by which a structure or part is made to describe a cone, the apex of the cone being a fixed point (e.g. the circular movement of a a ball and socket joint).

Contraction: shortening and/or development of tension in muscle.

concentric contraction: contraction of muscle resulting in approximation of attachments.

Eccentric contraction: lengthening of muscle during contraction due to an external force.

Isolytic contraction: 1. contraction of a muscle against resistance while forcing the muscle to lengthen 2. Operator force greater than patient force.

Isometric contraction. 1. Change in the tension of a muscle without approximation of muscle origin and insertion 2. Operator force equal to patient force.

Isotonic contraction: 1. Approximation of the muscle origin and insertion without change in its tension; 2. Operator force less than patient force

Contracture: a condition of fixed high resistance to passive stretch of a muscle, resulting from fibrosis of the tissues supporting the muscles or the joints or from disorders of the muscle fibers.

Dupuytyen's contracture: shortening, thickening and fibrosis of the palmar fascia, producing a flexion deformity of a finder (Dorland)

Cranial rhythmic impulse: a palpable, rhythmic fluctuation believed to be synchronous with the primary respiratory mechanism. (Term coined by Drs. John & Rachel Woods)

Craniosacral mechanism: a term used to refer to the anatomic connection between the occiput and the sacrum by the spinal dura mater, as used by Dr. Sutherland in any other sense.

– D –

Decompensation: a dysfunctional, persistent patter, in some cases reversible, resulting when homeostatic mechanisms are partially or totally overwhelmed.

– E –

effleurage: stroking movement in massage used to move lymphatic fluids.

elasticity: ability of a strained body or tissue to recover its shape after deformation.

end feel: perceived quality of motion as an anatomic or physiologic restrictive barrier is approached.

enthesitis: traumatic disease occuring at the insertion of muscles where recurring concentration of muscle stress provokes inflammation with a strong tendancy toward fibrosis and calcification (Stedman); inflammation of the muscular or tendinous attachment to bone (Dorland).

ERS: a descriptor of spinal somatic dysfunction used to denote a combination extended (E), rotated (R), and sidebent (S) vertebral position.

Exhalation rib: 1. A somatic dysfunction usually characterized by a rib being held in a position of exhalation such that motion toward exhalation is more free and motion toward inhalation is restricted; synonyms: inhalation restriction of rib(s), exhalation strain, depressed rib 2. An anterior tender point in strain-counterstrain.

Extension: 1. Accepted universal term for backward motion in a saggital plane of the spine about a transverse axis; in a vertebral unit when the superior part moved backward; 2. In extremities, it the straightening of a curve or angle (biomechanics); 3. Separation of the ends of a curve in a spinal region.

Extrinsic corrective forces: treatment forces, the sources of which are external to the patient; they may include operator effort, effect of gravity, mechanical tables.

– F –

Facilitation: 1. The maintenance of a pool of neurons (e.g., premotor neurons, motorneurons or preganglionic sympathetic neurons on one or more segments of the spinal cord.) in a state of partial or subthreshold excitation; in this state, less afferent stimulation is required to trigger the discharge of impulses 2. A theory regarding the neurophysiolgical mechanisms underlying the neuronal activity associated with somatic dysfunction 3. Facilitation may be due to sustained increase in afferent input, aberrant patterns of afferent input, or changes within the affected neurons themselves or their chemical environment. Once established facilitation can be sustained by normal central nervous system (CNS) activity.

Fascial patterns: systems for classifying and/or recording the preferred directions of fascial motion throughout the body in classifiable combinations of regional compensatory change major systems of fascial patterns include the observations of W. Neidner, D.O. and J. Gordon Zink, D.O.

FRS: a descriptor of spinal somatic dysfunction used to denote a combination flexed (F), rotated (R ) and sidebent (S) vertebral position.

– G –

Guiding: gentle movement by the operator following the path of least resistance in the movement of a body part within its normal range.

– H –

Habituation: decreased response to repeated stimulation; hypothetically, a short-term (minutes or hours) decremental central nervous system (CNA) process; it interacts with the incremental CNS process of sensitization and yields a final behavioral outcome.

Health: adaptive and optimal attainment of physical, mental, emotional, spiritual, and environmental well-being.

Homeostasis: 1. Maintenance of static or constant conditions in the internal environment; 2. The level of well-being of an individual maintained by internal physiologic harmony; it is the result of a relatively stable state or equilibrium among the interdependent body functions.

Hypertonicity: a condition of excessive tone of the skeletal muscles; increased resistance of muscle to passive stretching.

Iliosacral motion: motion of the ilia on an inferior transverse axis through the sacrum, as occurs in walking; considered to be primarily influenced by the attachments and movements of the pelvis, hips and lower extremities.

– I –

Ilium, somatic dysfunction of: anterior (forward) innominate (iliac) rotation: a somatic dysfunction in which the anterior superior iliac spine (ASIS) is anterior and inferior to the contralateral landmark; the ilium moves more freely in an anterior inferior direction, and is restricted in posterior motion.

Inferior innominate: (iliac) shear: a somatic dysfunction (qv) in which the anterior superior iliac spine (ASIS) and posterior superior iliac spines (PSIS) are inferior to the contralateral landmarks;the ilium (innominate pelvic bone) moves more freely in an inferior direction and is restricted in superior motion.

Inflare: (of the ilium i.e., innominate) a somatic dysfunction of the ilium resulting in medial positioning of the anterior ileum (ASIS);the ilium moves more freely in a medial direction, restriction is in lateral direction.

Outflare: (of the ilium, i.e., innominate) a somatic dysfunction of the ilium resulting in lateral positioning of the anterior ilium (ASIS); the ilium moves more freely in a lateral direction, restriction is in medial direction.

Posterior: (background) innominate (iliac) rotation: a somatic dysfunction is which the anterior superior iliac spine (ASIS) are posterior and superior to the contralateral landmarks; the ilium moves more fully in a posterior direction and is restricted in an anterior inferior motion.

Superior innominate (iliac) shear: a somatic dysfunction in which the anterior superior iliac spine (ASIS) and posterior superior iliac spines (PSIS) are superior to the contralateral landmarks; the ilium (innominate pelvic bone) moves more freely in a superior direction and is restricted in inferior motion.

Inferior lateral angle (ILA) of the sacrum: the point on the lateral surface of the sacrum where it curves medially to the body of the fifth sacral vertebra (Gray's anatomy).

Inhalation rib: a somatic dysfunction usually 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; inhaled rib, anterior rib, inhalation strain, elevated rib, exhalation restriction.

Innominate, reflex: 1. In osteopathic usage, a term that described the application of steady pressure to soft tissues to effect relaxation and normalize reflex activity, 2. Effect on antagonist muscles due to reciprocal innervation when the agonist is stimulated; see laws, Sherrington's osteopathic manipulative treatment; inhibitory pressure treatment.

Innominate bone: now called hip bone, pelvic bone, or os coxae; the pelvis is made up of the two innominate bones, the sacrum and coccyx, see hip bone; see ilium, somatic dysfunction of.

Intersegmental motion: designates relative motion taking place between tow adjacent vertebral segments or within a vertebral unit; described as the upper vertebral segment moving on the lower.

Intrinsic corrective forces: voluntary or involuntary forces from within the patient that a assist in the manipulative treatment process. (For comparison, see extrinsic corrective forces)

Isokinetic exercise: exercise using a constant speed of movement of the body part.

– K –

Kinesthesia: the sense by which muscular motion, weight, position, etc. are perceived.

Kinetics: the body of knowledge that deals with the effects of forces that produce or modify body motion.

Klapping: striking the skin with cupped palms to produce vibrations with the intention of loosening material in the lumen of hollow tubes or sacs within the body, particularly the lungs.

Kneading: a soft tissue technique which utilizes an intermittent force applied perpendicular to the long axis of the muscle.

Kyphosis: 1. The exaggerated (pathologic) AP curve of the thoracic spine with concavity anteriorly; 2. Abnormally increased convexity in the curvature of the thoracic spine as viewed from the side (Dorland)

– L –

Lateral flexed: a term used to describe a position of a vertebral body; defined as the movement of a point on the anterior on the anterior-superior aspect of the vertebral body about an anteriorposterior axis in a coronal plane.

Law, Head's: when a painful stimulus is applied to a body part of low sensitivity (e.g viscus) that is in close central connection with a point of higher sensitivity rather than at the point where the stimulus was applied.

Law, Wolff's: every change in form and function of a bone or in its function alone, is followed by certain definite changes in its internal architecture, and secondary alterations in its external conformations (Stedman's 25th ed.) e.g., bone is laid down along lines of stress.

Laws, Sherrington's: 1. Every posterior spinal nerve root supplies a specific region of the skin, although fibers from adjacent spinal segments may invade such a region; 2. When a muscle receives a nerve impulse to contract, its antagoist receives, simutaneously, an impulse to relax. (These are only two of Sherrington's contributions to nuerophysiology; these are the ones most relevant to osteopathic principles).

Ligamentous strain: motion and/or positional asymmetry associated with elastic deformation of connective tissue (fascia, ligament, membrane).

Localization: 1. In manipulative technique, the precise positioning of the patient and vector application of forces required to produce a desired result; 2. The reference of a sense impression to a particular locality in the body.

Lordosis: 1. The anterior convexity in the curvature of the lumbar and cervical spine as viewed from the side; the term is used to refer to abnormally increased curvature (hollow back, saddle back, sway back) and to the normal curvature (normal lordosis) cf. Kyphosis and Scoliosis; (Dorland) 2. Hollow back or saddle back; an abnormal extension of deformity; anteriorposterior curvature of the spine, generally lumbar with the convexity looking anteriorly (Stedman).

Lymph pumps: see osteopathic manipulative treatment; pedal pump or thoracic pump.

– M –

Manipulation: therapeutic application of manual force; see also technique.

Manual medicine: the use of the hands to diagnose and treat disorders of the somatic system.

Massage: therapeutic friction, stroking, and kneading of the body; see also osteopathic manipulative treatment; soft tissue treatment.

Mechanoreceptor: a receptor excited by mechanical pressures or distortions, as those responding to touch and muscular contractions (Dorland).

Motion: 1. A change of position (rotation, and/or translation) with respect to a system; 2. An act or process of a body changing position in terms of direction, course and velocity.

Active motion: movement produced voluntarily by the patient.

Inherent motion: that spontaneous motion of every cell, organ, system and their component units within the body.

Passive motion: motion induced by the physician while the patient remains passive or relaxed.

Physiologic motion: changes in position of body structures within the normal range; see physiologic motion of the spine.

Translatory motion: motion of a body part along an axis; see translation.

– N –

Neutral: 1. The range of sagittal plane positioning in which the first principle of physiologic motion of the spine applied. 2. The point of balance of an articular surface from which all the motions physiologic to that articulation may take place.

Nociceptor: a peripheral nerve organ or mechanism for the appreciation and transmission of painful or infurious stimuli  (Stedman).

Non-neural: the range of sagittal plane spinal positioning in which the second principle of physiologic motion of the spine applies.

Normalization: the therapeutic use of anatomic and physiologic mechanics to facilitate the body's response toward hemeostasis and improved health.

NSR: A descriptor of spinal somatic dysfunction used to denote a combination neutral (N), sidebent (S) and rotated ( R ) vertebra position; similar descriptors may involve flexed (F) and extended (E) position; examples of combinations are FRS, ERS.

Nutation: nodding forward; anterior movement of the sacral base around a transverse axis in relation to the ilia, occurring during sphenobasilar extension of the craniosacral mechanism.

– O –

OMM: 1. Osteopathic manipulative medicine 2. Primary care specialty emphasizing in-depth application of osteopathic philosophy and special proficiency in osteopathic diagnosis and treatment.

OMT: see osteopathic manipulative treatment.

OP&P: osteopathic principles and practice.

Osteopathic lesion ( osteopathic lesion complex): term originally used to identify what is currently defined as somatic dysfunction; see somatic dysfunction.

Osteopathic manipulative treatment: (OMT): the therapeutic application of manually guided forces by an osteopathic physician to improve physiological function and/or support homeostastis; this is accomplished by a variety of techniques.

Active treatment (ART): a technique in which the person voluntarily performs a physician directed motion.

Articulatory treatment (ART) :a low velocity/moderate to high amplitude technique where a joint is carried through its full motion with the therapeutic goal of increased freedom range of motion.

Balanced ligamentous tension (BLT/LAS): see ligamentous articular strain.

Combined treatment: 1. Term coined by Paul Kimberly, D.O., to describe a technique where the initial movements are indirect as the technique is completed the movements change to direct forces. 2. A manipulative sequence involving two or more different techniques (e.g Spencer technique combined with muscle energy technique)

Counterstrain (CS): a system of diagnosis and treatment developed by Lawrence Jones, D.O., that considers the dysfunction to be continuing, inappropriate strain reflex, which is inhibited by applying a position of mild strain in the direction exactly opposite to that of the strain reflex; this is accomplished by use of the specific point of tenderness related to this dysfunction followed by specific directed positioning to achieve the desired therapeutic response.

Cranial treatment (CR): see primary respiratory mechanism; see also osteopathy in the cranial field.

Direct treatment (D/DIR): any technique engaging the restrictive barrier and then carrying the dysfunctional component into the restrictive barrier.

Exaggeration treatment: 1. Operator movement away from the restrictive barrier through and beyond the range of voluntary motion to a point of palpably increased tension. 2. An indirect procedure that involves carrying the dysfunction part away from the restrictive barrier tissue treatment: (ST), then applying a high velocity/low amplitude force in the same direction.

Facilitated positional release (FPR): a system of indirect myofascial release treatment developed by Stanley Schowitz, D.O. The component region of the body is placed into a neutral position, diminished tissue and joint tension, in all planes.

Inhibitory pressure treatment: the application of steady pressure to soft tissues to reduce reflex activity and produce relaxation.

Ligamentous articular strain (LAS/BLT): a set of myofascial release techniques described by Howard Lippincott, D.O., and Rebecca Lippincott, D.O.

Lymphatic pump: a term coined by C. Earl Miller, D.O., to describe the impact of intrathoracic pressure changes on lymphatic flow; this was the name originally given to the thoracic pump technique before the more extensive physiologic effects of the technique were recognized.

Mandibular drainage: a technique used to effect increased drainage of middle ear structures via the Eustachian tube and lymphatic.

Muscle energy treatment: a term used to described the form of osteopathic manipulative treatment in which the patient voluntarily moves the body as specifically directed by the physician ; this directed patient action is from a precisely controlled position against a defined resistance by the physician.

Myofascial treatment: any technique directed at the muscles and fascia.

Myofascial release treatment (MFR): treatment form first described by Andrew T. Still and his early students, which engages continual palpatory feedback to achieve release of myofascial tissues.

Direct MFR: a restrictive barrier is engaged for the myofascial tissues; the tissue is loaded with a constant force until tissue release occurs.

Indirect MFR: the dysfunctional tissues are guided along the path of least resistance until free movement is achieved.

Passive treatment: technique in which the patient refrains from voluntary muscle contraction.

Pedal pump: a venous and lymphatic drainage technique applied through the lower extremities; also called the pedal fascia pump or pedal pump.

Positional treatment: a direct segmental technique in which a combination of leverage, patient ventilatory movements and a fulcrum are used to achieve mobilization of the dysfunctional segment; may be combined with springing or thrust technique.

Range of motion treatment: active or passive movement of a body part to it physiologic or anatomic limit in any or all planes of motion.

Soft tissue technique : Soft procedure directed toward tissues other than skeletal or arthrodial elements: a direct technique which usually involves lateral stretching, linear stretching, deep pressure, traction and/or separation o muscle origin and insertion while monitoring tissue response and motion changes by palpation; also called myofascial treatment.

Spencer technique: a series of direct manipulative procedures to prevent or decrease soft tissue restrictions about the shoulder.

Springing treatment: a low velocity/moderate amplitude technique where the restrictive barier is engaged repeatedly to produce an increased freedom of motion.

Osteopathic Philosophy: osteopathic medicine is a philosophy of health care and a distinctive art, supported by expanding scientific knowledge; its philosophy embraces the concept of the unity of the living organism's structure (anatomy) and function (physiology). Its art is the application of the philosophy in the practice of medicine and surgery in all its branches and specialties. Its science included the behavioral, chemical, physical, spiritual and biological knowledge related to the establishment and maintenance of health as well as the prevention and alleviation of disease. Osteopathic concepts emphasize the following principles: 1. The human being is a dynamic unit of function 2. The body possesses self-regulatory mechanism which is self healing in nature. 3. Structure and function are interrelated at all levels 4. Rational treatment is based on these principles.

Osteopathic postural examination: the part of the osteopathic musculoskeletal examination that focuses on the static and dynamic responses of the body to gravity while in the erect position.

Osteopathic structural examination: the examination of a patient by a an osteopathic physician with emphasis on the neuromuscular-skeletal system including palpatory diagnosis for somatic dysfunction and viscerosomatic change in the context of total patient care.The examination is concerned with range of motion of all part of the body performed with the patient in multiple positions to provide static and dynamic evaluation.

Osteopathy (osteopathic medicine): a system of medical care with a philosophy that combines the needs of the patient with current practice of medicine, surgery and obstetrics and emphasis on the interrelationships between structure and function, and an appreciation of the body's ability to heal itself.

Osteopathy in the cranial field (OCF): diagnosis and treatment by an osteopathic physician using the primary respiratory mechanism. 1. Refers to the work of William G. Sutherland, D.O., in applying the philosophy and principles of osteopathy to the whole body, 2. Title of reference book by Harold Magoun, Sr., D.O.

– P –

Palpation: the application of the fingers to the surface of the skin or other tissues, using varying amounts of pressure, to selectively determine the condition of the parts beneath.

Palpatory diagnosis: a term used by osteopathic physicians to denote the process of palpating the patient to evaluate the neuromusculoskeletal and visceral systems.

Palpatory skills: sensory skills used in performing palpatory diagnosis and osteopathic manipulative treatment.

Patient cooperation: voluntary movement by the patient (on instruction from the operator) to assist in the palpatory diagnosis and treatment process.

Pelvic declination (pelvic unleveling) pelvic rotation about an A-P axis.

Pelvic index: an objective radiographic measurement representing the relative positions of the sacrum and innominate; normal values are age-related and increase in subjects with saggital plane postural decompensation.

Pelvic rotation: movement of the entire pelvis in a relatively horizontal plane about a vertical (longitudinal) axis.

Pelvis sideshift: deviation of the pelvis to the right or left of the central vertical axis as translation along the horizontal (z) axis, usually observed in the standing position.

Pelvic tilt: pelvic rotation about a transverse ( horizontal) axis (forward or backward tilt) or about an anterior-posterior axis (right or left side tilt)

Petrissage: deep kneading or squeezing action to express swelling.

Physiologic motion of the spine: Principles I and II of thoracic and lumbar spinal motion described by Harrison H. Fryette, D.O. (1918) Principle III was proposed by C.R. Nelson, D.O. (1948)

Plagiocephaly: an asymmetric condition of the head.

Plane: a flat surface determined by the position of three points in space; any of a number of imaginary surfaces passing through the body and dividing it into segments.

Coronal plane: frontal plane.

Frontal plane: a plane passing longitudinally through the body from one side to the other and dividing the body into anterior and posterior portions.

Saggital plane: a plane passing longitudinally through the body from front to back and dividing it into right and left portions; the median or midsaggital plane divides the body into approximately equal right and left portions.

Plastic deformation: a non-recoverable deformation; see also elastic deformation.

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; usually refers to a prominent transverse process.

Postural decompensation: distribution of body mass away from ideal when postural homeostatic mechanisms are overwhelmed; occurs in a ll cardinal plane but is classified by the major plane(s) affected.

Posture: position of the body; the distribution of body mass in relation to gravity.

Primary machinery of life: the neuromusculoskeletal system.

Primary respiratory mechanism: a model proposed by W. Sutherland, D.O., to describe the interdependent functions among five body components as follows: 1 the inherent motility of the brain and spinal cord 2. Fluctuation of the cerebrospinal fluid 3. Motility of the intracranial and intraspinal membranes 4. Articular mobility of the cranial bones 5. The involuntary mobility of the sacrum between the ilia (pelvic bone)

Primary: refers to the internal tissue respiratory process.

Respiratory: refers to the process of internal respiratory, i.e., the exchange of respiratory gases between tissue cells and their internal environment consisting of fluids bathing the cells.

Mechanism: refers to the interdependent movement of tissue and fluid with a specific purpose.

Pronation: in relation to the anatomical position, as applied to the hand, rotation of the forearm in such a way that the palmar surface turns backward (internal rotation) in relationship to the anatomical position; applied to the foot, a combination of eversion and abduction movements taking place in the tarsal and metatarsal joints, resulting in lowering of the medial margin of the foot.

Prone: lying face downward.

Proprioception: the sensing of motion and position of the body.

Proprioceptor: sensory nerve terminals found in muscles, tendons and joint capsules which give information concerning movements and position of the body (Dorland)

Pubes, somatic dysfunction of:

Inferior pubic shear (inferior pubis): a somatic dysfunction in which one side of the pubic symphysis is inferior to the contralateral side as the result of a shearing in the saggital plane.

Superior pubic shear (superior pubis) reciprocal of interior pubis.

Pump handle rib motion: movement of the ribs during respiration such that with inhalation the anterior aspect of the rib moves cephalad and causes an increase in the anteriorposterior diameter of the thorax ; this type of rib motion is found predominately in the upper ribs decreasing from the upper to the lower ribs.

– R –

Reciprocal tension membrane: the intracranial and spinal dural membrane including the falx cerebri, falx cerebelli, tentorium and spinal dura.

Reflex: an involuntary nervous system response to a sensory input; the sum total of any particular involuntary activity.

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 an unrelated outside event; soon the physiological function starts whenever the outside event occurs.

Red reflex: the erythematous biochemical reaction ( reactive hyperemia) of the skin in an area that has been stimulated mechanically by friction; the reflex is greater in degree and duration in an area of acute somatic dysfunction; it is a reflection of the segmentally related sympathicotonia commonly observed in the paraspinal area 2. A red glow reflected from the fundus of the eye when a light is cast upon the retina.

Somato-somatic reflex: localized somatic stimuli producing patterns of reflex response in segmentally related somatic structures.

Somato-visceral reflex– localized somatic stimulation producing patterns of reflex response in segmentally related visceral structures.

Viscero-somatic reflex: localized visceral stimuli producing patterns of reflex in segmentally related somatic structures.

Viscero-visceral reflex: localized visceral stimuli producing patterns of reflex response in segmentally related visceral structures.

Respiratory cooperation: a physician-directed inhalation and/or exhalation by a the patient to assist the manipulative treatment process.

Rib dysfunction: (rib lesion) a somatic dysfunction in which movement or position of one or several ribs is altered or disrupted; for example, an elevated rib is one held in a position of inhalation such that motion toward inhalation is freer, and motion toward exhalation is freer and there is a restriction in inhalation.

– S –

Sacral motion , axis of: motion of the sacrum about any of its hypothetical axes.

Anterior -posterior (x) axis: axis formed at the line of intersection of a saggital and transverse plane.

Oblique axis (diagonal) a hypothetical functional axis proposed by Fred. Mitchell D.O., that is 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.

Longitudinal axis: the hypothetical axis formed at the line of intersection of the midsaggital plane an a coronal plane.

Postural axis: see middle (postural) transverse axis.

Superior transverse axis: see superior (respiratory) axis.

Transverse (z) axes: formed by in intersection of the coronal and transverse planes abut which flexion/extension occurs.

Inferior transverse axis (innominate axis) the hypothetical functional axis of sacral motion proposed by Fred Mitchell D.O., that passes from side to side on a line through the inferior auricular surface of the sacrum, and represents the axis for movement of the ilia on the sacrum.

Middle transverse axis (postural axis) the hypothetical functional axis of sacral flexion/extension in the standing position proposed by Fred Mitchell D.O., passing from side to side through the anterior aspect of the sacrum at the level of the second sacral segment.

Superior transverse axis (respiratory axis): the hypothetical transverse axis about which the sacrum moves during the respiratory cycle proposed by Fred Mitchell D.O.  It passes from side to side through the articular processes posterior to the point of attachment of the dura to the level of the second sacral segment; involuntary sacral motion occurring as a part of the craniosacral mechanism is believed to occur about this axis.

Respiratory axis: see transverse axis.

Vertical (y) axis (longitudinal): the axis formed by the intersection of the sagittal and coronal planes.

Sacral torsion: a somatic dysfunction in which a torque occurs between the sacrum and the lumbar spine.

Sacrum, somatic dysfunction of (sacral somatic dysfunction): any group of somatic dysfunction involving primarily the sacrum.

Anterior sacrum: a positional term referring to sacral somatic dysfunction in which one side of the sacral base relative to the pelvic bones has rotated forward and sidebent to the side opposite the rotation about a diagonal axis: the dysfunction is named for the side on which the forward rotation occurs; anterior sacrum right described a condition in which the sacrum is rotated left and side-bent right, such that rotation left and sidebending right are freer motions and rotation right and sidebending left are restricted; the use of the term anterior (or posterior ) to describe dysfunction of the sacrum used the pelvic bones for reference.

Extension dysfunction of the sacrum (sacral base posterior): 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 and forward movement is restricted; this is the reciprocal of flexion sacrum.

Flexion dysfunction of the sacrum (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 moved anteriorly between the pelvic bones; forward movement of the sacral base is freer and backward movement is restricted 2. Reciprocal of an extension sacrum.

Posterior sacrum: a positional term referring to a sacral somatic dysfunction in which the sacral base has rotated backward and sidebent to the side opposite the rotation; the dysfunction is named for the side on which the backward rotation occurs.

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.

Sacral shear (unilateral sacral flexion): a non-physiological sacral somatic dysfunction which is usually traumatically induced; characterized by a deep sacral sulcus and ipsilateral inferior-posterior inferiorlateral angle of the sacrum.

Sacral torsion: rotational motion about an oblique or diagonal sacral axis; primarily a term used to designate somatic dysfunction that results in torsion at the L/S torsion. This is based on the cycle of walking. The term torsion originates from the fact that the sacrum has rotated in a direction opposite to the supported vertebra (sacrum rotated left, the lumbar spine rotates right).  A left rotation about a left oblique axis produces a right anterior sacral base wit a deep right sacral sulcus, a more posterior left inferiorlateral angle and a decrease in the tension of the right sacrotuberous ligament. A backward torsion occurs when the lumbar spine is in non-neutral and the sacral base than rotates posteriorly about an oblique axis. Backward or non-neutral torsion are identified for convenience by right on left or left on right.

Translated sacrum: a non-physiological sacral somatic dysfunction as a result of trauma in which the entire sacrum has moved forward between the pelvic bones (an anterior translated sacrum) or backward between the pelvic bones (posterior translated sacrum).

Anterior translated sacrum: a sacral somatic dysfunction in which the entire sacrum has moved forward between the ilia; anterior motion is freer, and there is a restriction to posterior motion.

Posterior translated sacrum: a sacral somatic dysfunction in which the entire sacrum has moved backward between the ilia; posterior motion is freer, and there is a restriction to anterior motion.

Scoliosis: 1. Pathological or functional lateral curvature of the spine 2. An appreciable lateral deviation in the normally straight vertical line of the spine.

Secondary joint motion: involuntary or passive motion of a joint; also called accessory joint motion.

Segment: a portion of a larger body or structure set off by natural or arbitrarily established boundaries; often equated with spinal segment, i.e., 1. To described a single vertebrae 2. A portion of the spinal cord corresponding to the sits of origin of of individual spinal nerves.

Segmental diagnosis: the final stage of the spinal somatic examination in which the nature of the somatic problem is detailed at a segmental level.

Segmental motion: movement within a vertebral unit described by displacement of a point at the anterior-superior aspect of the superior vertebral body.

Shear: an action of force causing or tending to cause two contiguous parts of an articulation to slide relative to each other in a direction parallel to their plane of contact.

Sidebending: movement in a coronal (frontal) plane about an anterior-posterior (x) axis; also called lateral flexion, lateroflexion or flexion right (or left).

Skin drag: sense of resistance to light traction applied to the skin; related to the degree of moisture and degree of sympathetic nervous system activity.

Somatic dysfunction: impaired or altered function of related components of the somatic (body framework) system: skeletal, arthrodial, and myofascial structures, and related vascular, lymphatic, and neural elements. Somatic dysfunction is treatable using osteopathic manipulative treatment.

The positional and motion aspects of somatic dysfunction are best described using at least one of three parameters: 1. The position of a body part as determined by palpation and referenced to its adjacent defined structure. 2. The directions in which motion is freer. 3. The directions in which motion is restricted.

Somatic dysfunction, acute: immediate or short-term impairment or altered function of related components of the somatic (body framework) system.

Somatic dysfunction, chronic: impairment or altered function of related components of the somatic system.

Somatic dysfunction, type I: a group of thoracic and/or lumbar vertebrae in which the freedoms of motion are in neutral with sidebending and rotation in opposite directions (rotation occurs toward the convexity of the curve).

Somatic dysfunction, type II: thoracic or lumbar somatic dysfunction of a single vertebral unit in which the vertebra is flexed or extended with sidebending and rotation in the same direction (rotation occurs into the concavity of the curve).

Spondylitis: inflammation of vertebrae.

Spondylolisthesis: anterior displacement of one vertebra relative to one immediately below (usually L5 over the body of the sacrum or L4 over L5).

Spondylolysis: dissolution of a vertebra; aplasia of the vertebral arch, and separation at the pars interarticularis, platyspondylia, pre-spondylolisthesis.

Spondylosis: 1. Ankylosis of adjacent vertebral bodies 2. Degeneration of the intervertebral disk.

Sprain: stretching injuries of ligamentous tissue. Grade 0: plastic deformation of the ligament without any tissue tearing; first degree: microtrauma; second degree; partial tear; third degree; complete disruption.

Still, M.D., Andrew Taylor: founder of osteopathy; 1828-1917; first announced the tenets of osteopathy on June 22, 1874, established the American School of Osteopathy in 1892 at Kirksville, MO.

Still point: a term used by W. G. Sutherland, D.O., to identify and describe the brief cessation of rhythm attributed to the fluctuation of cerebrospinal fluid observed by palpation during osteopathic manipulative treatment when a point of balanced membranous tension is achieved.

Strain: 1. Stretching injuries of muscle tissue; 2. Distortion with deformation of tissue.

Stretching: separation of the origin and insertion of a muscle and/or attachments of fascia and ligaments.

Subluxation: 1. Partial or incomplete dislocation; 2. A term describing an abnormal anatomical position of a joint which exceeds the normal physiologic limit but does not exceed the joints anatomical limit.

Supination: 1. Beginning in anatomical position, applied to the hand, the act of turning the palm forward (anteriorly) or upward, performed by lateral external rotation of the forearm; 2. Applied to the foot, it generally applied to movements resulting in raising of the medial margin of the foot, hence of the longitudinal arch; a compound motion of plantar flexion, adduction and inversion.

Symphyseal shear: the resultant of an action or force causing or tending to cause the two parts of the symnphysis to slide relative to each other in a direction parallel to their plane of contact; it is usually found in an inferior/superior direction but is occasionally found to be in an anterior/posterior direction.

– T –

T.A.R.T:  a mnemonic for the four diagnostic criteria of somatic dysfunction-tissue texture abnormality, asymmetry, restriction of motion and tenderness-any one of which must be present for the diagnosis:

Technique: methods, procedures and details of a mechanical process or surgical operation.

Tenderness: 1. Discomfort or pain elicited by the physician through palpation; 2. A state of unusual sensitivity to touch or pressure.

Tender points: 1. A system of points originally described by Lawrence Jones, D.O., in strain/counterstrain diagnosis and treatment; 2. Small hypersensitive points in the myofasical tissues of the body used as diagnostic criteria and treatment monitors.

Thoracic inlet: 1. The functional thoracic inlet consists of T1-4 vertebra, ribs 1 and 2 plus their costicartilages, and the manubrium of the sternum. 2. The anatomical thoracic inlet consists of T1 vertebra, the first ribs and their costal cartilage's, and the superior end of the manubrium.

Tissue texture abnormality: A palpable change in tissues from skin to periarticular structures that represents any combination of the following signs: vasodilatation, edema, flaccidity, hypertonicity, contracture, fibrosis, and the following symptoms: itching, pain, tenderness, parasthesia.

Tonus: the slight continuous contraction of muscle which in skeletal muscles aids in the maintenance of posture and in return of blood to the heart (Dorland).

myogenic tonus: 1. Tonic contraction of muscle dependent on some property of the muscle itself or of its intrinsic nerve cells 2. Contraction of a muscle caused by intrinsic properties of the muscle or by its intrinsic innervation (Stedman).

Torsion: 1. A motion or state where one end of a part is twisted about a longitudinal axis while the opposite end is held fast or turned in the opposite direction 2. Motion of the sacrum about an oblique axis, with sacral rotation opposite to rotation of L5. 3. An unphysiologic motion pattern about an anteroposterior axis of the sphenobasilar symphysis/synchondrosis.

Traction: a linear force acting to draw structures apart.

Transitional segment (transitional vertebral segment): a congenital anamoly of a vertebra in which it develops characteristics of the adjoining structure or region, e.g., lumbosacral, cervicothoracic. The clinical significance of this lies in its aberrant motion characteristics; gross postural effects on the super incumbent spinal column or pseudoarthrosis between the enlarged transverse processes and either the sacrum or ilia.

Lumbarization: a transitional segment in which the first sacral segment becomes like an additional lumbar vertebra articulating with the second sacral segment.

Sacralization: 1. Incomplete separation and differentiation of the fifth lumbar vertebra (L5) such that it takes on characteristics of a sacral vertebra. 2. When transverse processes of the fifth lumbar are atypically large, causing pseudoarthrosis with the sacrum and/or ilia referred to as batwing deformity if bilateral.


Translation: motion along an axis


– V –

Vertebral unit: two adjacent vertebrae with their associated intervertebral disk, arthrodial, ligmentous, muscular, vascular, lymphatic and neural elements.

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