Diagnostic Mnemonic
TART (Tissue, Asymmetry, Restriction, Tenderness)
Fryette Law I
Neutral: SB & R in opposite directions (group curve)
Fryette Law II
Non-neutral: SB & R in same direction (single segment)
Direct vs Indirect
Direct moves into barrier; Indirect moves away (ease)
The TART Framework & Somatic Dysfunction
Somatic dysfunction is an impaired or altered function of related components of the somatic system (skeletal, arthrodial, and myofascial structures, and related vascular, lymphatic, and neural elements). Diagnosing a somatic dysfunction requires at least two of the four TART criteria:
T — Tissue Texture Changes
Palpable alterations in cutaneous, subcutaneous, and fascial tissues reflecting autonomic and biomechanical tone.
A — Asymmetry
Visual and palpable misalignment of anatomical landmarks comparing contralateral sides.
R — Restriction of Motion
Reduction in active or passive physiologic motion. Somatic dysfunction is always named for its freedom of motion (where it moves easiest), NOT where it is restricted.
T — Tenderness
Patient-reported discomfort upon palpation. The only purely subjective criterion of TART.
Acute vs. Chronic Tissue Texture Changes
Board vignettes heavily contrast acute vs chronic tissue presentation to test autonomic chronicity:
| Sign / Characteristic | Acute Somatic Dysfunction | Chronic Somatic Dysfunction |
|---|---|---|
| Temperature | Warm / Increased heat (hyperemia) | Cool / Decreased heat (ischemia) |
| Skin Texture / Moisture | Moist / Boggy / Erythematous | Dry / Scaly / Thin / Pale |
| Tissue Consistency | Edematous, swollen, boggy, spongy | Fibrotic, stringy, ropy, doughy |
| Erythema Friction Rub | Red flare persists (vascular flush) | Redness blanches rapidly / minimal flush |
| Muscle Tone | Hypertonic, spasm, acute guarding | Contracture, chronic hypotonicity / atrophy |
| Pain Quality | Sharp, intense, well-localized | Dull, ache, diffuse, dragging |
Fryette's Principles of Spinal Motion
Formulated by Harrison Fryette, DO, these laws govern thoracic and lumbar spinal mechanics. Note: Fryette's laws do NOT apply to the cervical spine (OA, AA, C2-C7).
Principle I (Neutral Mechanics)
When the thoracic or lumbar spine is in neutral (without marked flexion or extension), sidebending and rotation occur in opposite directions (e.g., T3-T7 N SLRR). Typically affects multiple segments (group curves).
Principle II (Non-Neutral Mechanics)
When the thoracic or lumbar spine is in significant flexion or extension, sidebending and rotation occur in the same direction (e.g., L3 F SRRR). Typically affects a single vertebral segment, often secondary to acute trauma.
Principle III (Nelson's Principle)
Initiating motion in a vertebral segment in any plane of motion will reduce or modify motion of that segment in the other two planes.
Physiologic, Anatomic & Pathologic Barriers
Understanding barriers is essential for selecting direct versus indirect OMT modalities:
Physiologic Barrier
The limit of active motion achieved by voluntary muscle contraction. Can be altered by warm-up, stretching, or conditioning.
Anatomic Barrier
The ultimate limit of passive motion imposed by bone, ligamentous architecture, and joint capsule. Moving past this barrier results in tissue disruption or fracture.
Pathologic / Restrictive Barrier
An unnatural barrier that occurs BEFORE the physiologic barrier, caused by somatic dysfunction, edema, muscle spasm, or contracture.
COMLEX / OMM Integration
NBOME High-Yield Correlate
Naming Conventions & Treatment Classifications
- Always name the dysfunction for the freedom of motion: If T5 moves freely into extension, right sidebending, and right rotation, it is named:
- Direct techniques (Muscle Energy, HVLA, Articulatory, Springing): Engage and carry the dysfunctional component toward and through the restrictive barrier.
- Indirect techniques (Counterstrain, Balanced Ligamentous Tension, Facilitated Positional Release, Still): Move the dysfunctional component away from the restrictive barrier toward the point of balanced tissue tension (ease).
T5 E SRRR.- Direct techniques (Muscle Energy, HVLA, Articulatory, Springing): Engage and carry the dysfunctional component toward and through the restrictive barrier.
- Indirect techniques (Counterstrain, Balanced Ligamentous Tension, Facilitated Positional Release, Still): Move the dysfunctional component away from the restrictive barrier toward the point of balanced tissue tension (ease).
Board Traps & Common Distractors
- Trap: Saying a dysfunction is named for where it is restricted. It is ALWAYS named for where it goes easily.
- Trap: Applying Fryette's laws to the OA or AA joints. The occiput-atlantal joint sidebends and rotates opposite regardless of flexion/extension, and the AA joint is purely rotational.
- Absolute Contraindication for Direct Techniques: Never perform HVLA in areas of metastatic bone disease, osteomyelitis, acute fracture, severe osteoporosis, or rheumatoid arthritis/Down syndrome at the AA joint.