: The Basics
Comprehensive OMT reference hub, interactive cheat sheets, and board review notes for COMLEX Level 1, 2-CE, and 3.
Key Takeaway
Somatic dysfunction is diagnosed by TART criteria (Tenderness, Asymmetry, Restriction of motion, Tissue texture change). Distinguish acute (edematous, warm, boggy) from chronic (fibrotic, cool, ropy) findings. Fryette's Law I applies to neutral multi-segment groups (opposite SB/rotation); Law II applies to non-neutral single segments (same SB/rotation); Law III states motion in one plane reduces motion in all other planes.
1. Somatic Dysfunction & TART Diagnostic Criteria
Somatic dysfunction is defined as impaired or altered function of related components of the somatic system (skeletal, arthrodial, and myofascial structures, and related vascular, lymphatic, and neural elements). Somatic dysfunction is always named for the POSITION OF EASE (freedom of motion), NOT the restriction!
| TART Criterion | Diagnostic Sign / Finding | Clinical Palpation Assessment |
|---|---|---|
| T: Tenderness | Subjective pain or uncomfortable sensation produced by palpation. | Universal finding; present in both somatic dysfunction and tenderpoints. |
| A: Asymmetry | Observable or palpable difference in position or contour. | Assessed by comparing anatomical landmarks (e.g., transverse processes, ASIS). |
| R: Restriction of Motion | Impaired movement through normal physiological range. | Assessed during active (patient-driven) and passive (physician-driven) motion testing. |
| T: Tissue Texture Changes | Palpable alterations in cutaneous, subcutaneous, and fascial layers. | Acute: boggy, warm, moist, hypertonic; Chronic: cool, pale, ropy, fibrotic. |
2. Acute vs. Chronic Somatic Dysfunction Matrix
| Feature / Finding | Acute Somatic Dysfunction | Chronic Somatic Dysfunction |
|---|---|---|
| History & Duration | Recent trauma, sudden onset, short duration. | Long-standing, repetitive microtrauma, compensation. |
| Pain & Sensation | Severe, sharp, well-localized, constant pain. | Dull, aching, diffuse, intermittent discomfort. |
| Skin & Temperature | Warm, red, erythematous, moist (increased sudomotor activity). | Cool, pale, dry (decreased sudomotor activity). |
| Musculature & Tone | Hypertonic, spasm, rigid, boggy, edematous. | Hypotonic, flaccid, ropy, fibrotic, stringy, tissue wasting. |
| Vascular Response | Vasodilation, acute inflammation, erythema test positive (red line persists). | Vasoconstriction, blanched erythema test (white line persists). |
| Sympathetic Tone | Increased localized sympathetic outflow. | Systemic or blunted chronic sympathetic adaptation. |
3. Anatomical & Physiological Motion Barriers
A barrier is a limit to motion. Understanding barriers is essential for selecting direct versus indirect OMT modalities.
| Barrier Type | Definition & Mechanism | Clinical Significance in OMT |
|---|---|---|
| Physiological Barrier | The limit of active patient-driven motion. | Normal end-range of voluntary movement. |
| Anatomical Barrier | The limit of passive motion imposed by ligaments, capsules, and bones. | Moving beyond this barrier causes structural damage / fracture. |
| Restrictive (Pathological) Barrier | An abnormal barrier located BEFORE the physiological barrier. | Caused by somatic dysfunction; restricts range of motion. |
| Elastic Barrier | The range between physiological and anatomical barriers. | Passive stretch space where HVLA thrust is executed. |
DIRECT vs. INDIRECT OMT BARRIER ENGAGEMENT: - Direct Techniques: The physician moves the dysfunctional body part TOWARD AND THROUGH THE RESTRICTIVE BARRIER (e.g., HVLA, MET, Direct MFR). - Indirect Techniques: The physician moves the dysfunctional body part AWAY FROM THE BARRIER TOWARD THE POSITION OF EASE (e.g., Counterstrain, FPR, Indirect MFR).
4. Fryette's Laws of Spinal Motion
| Fryette's Law | Spinal Condition & Setup | Coupling Rule | Spinal Regions Covered |
|---|---|---|---|
| Law I (Type I Mechanics) | Spine is in NEUTRAL (no marked F or E). Group of 3+ adjacent vertebrae. | Sidebending and Rotation occur to OPPOSITE SIDES ($N S_L R_R$ or $N S_R R_L$). | Thoracic and Lumbar spine ONLY. (Not applicable to Cervical spine!) |
| Law II (Type II Mechanics) | Spine is in NON-NEUTRAL (marked Flexion or Extension). Single segment. | Sidebending and Rotation occur to the SAME SIDE ($F/E S_R R_R$ or $F/E S_L R_L$). | Thoracic, Lumbar, and Typical Cervical (C2–C7) spine. |
| Law III | Motion introduced in any one plane (sagittal, coronal, transverse)... | ...modifies and REDUCES MOTION IN THE OTHER TWO PLANES. | Applies to ALL spinal segments across the entire vertebral column. |
5. OMT Modality Classification Matrix
| Technique Modality | Direct vs. Indirect | Active vs. Passive | Primary Mechanism / Target |
|---|---|---|---|
| High-Velocity Low-Amplitude (HVLA) | Direct | Passive | Rapid therapeutic thrust through restrictive barrier; resets GTO. |
| Muscle Energy Technique (MET) | Direct | Active | Patient contracts against isometric resistance; post-isometric relaxation. |
| Counterstrain | Indirect | Passive | Hold position of comfort for 90 seconds; quiets hyperactive $Ia$ muscle spindles. |
| Facilitated Positional Release (FPR) | Indirect | Passive | Neutralize + compress/distract + hold 3–5 seconds. |
| Still Technique | Indirect $\rightarrow$ Direct | Passive | Start in ease $\rightarrow$ apply vector force $\rightarrow$ sweep through barrier. |
| Myofascial Release (MFR) | Direct or Indirect | Passive or Active | Continuous low load to fascia; viscoelastic creep and hysteresis. |
| Lymphatic Pumps | Direct | Passive or Active | Enhance transdiaphragmatic pressure gradients and venous return. |
| Cranial OMT (OCF) | Direct or Indirect | Passive | Modulate Primary Respiratory Mechanism (PRM) & CSF fluctuation. |
6. COMLEX Practice Knowledge Check
Source
Based on the publicly available table of contents and topic organization of OMM Review: A Comprehensive Review of Osteopathic Medicine. All notes are original; no copyrighted text, figures, or full source material is included.