Overview

The osteopathic profession subscribes to the following tenets (Foundations for Osteopathic Medicine, 2^nd ed, pg. 5, Table 1.1):

• A healthy state exists as long as there is normal flow of body fluids and nerve activity.
• Illness is often caused by mechanical impediments to normal flow of body fluids and nerve activity.
• A healthy state exists as long as there is normal flow of body fluids and nerve activity.

These points could be summarized by saying, "Dysfunctional structures result in impairment of normal function". For example,

• Restriction of the normal range of motion of the thoracic cage and the thoracoabdominal diaphragm during inspiration and expiration may result in diminished oxygen exchange, decreased motility within the bowels, and reduced lymphatic drainage.
• Diminished return of lymphatic fluid to the venous system may result in edema and contribute to pulmonary congestion.
• Abnormal reflex activity may result in increased tension within the thoracic musculature that may result in pain and/or discomfort while breathing.

Somatic dysfunction may be defined as an impairment, or altered function, of related components of the somatic (body framework) system: skeletal, arthrodial, and myofascial structures, and related vascular, lymphatic, and neural elements (Foundations for Osteopathic Medicine, 2^nd ed, pg. 1249).

Somatic Dysfunction may be diagnosed by the presence of some, but not necessarily all, of the following:

• Tissue Texture Abnormalities -- Surrounding tissues may feel hypertonic, rigid, fibrosed, atrophied, or edematous.
• Asymmetry of Bony Landmarks and/or Function -- Bones, muscles, or joints may lack symmetry when compared to related structures.
• Restriction of Motion -- A joint with a somatic dysfunction will have abnormal characteristics of motion. During the diagnostic process you should be constantly asking yourself the following four questions:
1. Is the total range of motion symmetric?
2. Is the total range of motion reduced from normal?
3. What is the quality of the motion?
4. What is the characteristic feel at the end point of motion?
• Tenderness to Touch -- Pain may result from palpation of tissues associated with somatic dysfunction.

Somatic dysfunction can be further classified as shown in the following table (Foundations for Osteopathic Medicine, 2^nd ed, pg. 562, Table 38.1).

Diagnostic Element	Characteristics of Acute Condition	Characteristics of Chronic Condition
History	Recent injury	Long-standing condition
Tissue Texture Changes	Hypertonic muscles, muscle spasms, boggy edema, moist skin	Decreased muscle tone, dry skin, decreased or no edema, fibrotic and/or ropy tissues
Asymmetry	Present	Present with compensation in other parts of the body
Restriction	Present, painful with movement, sluggish quality	Present, decreased or no pain, normal quality within the range that remains
Tenderness	Severe, sharp, minimal evidence of somato-visceral effects	Dull, achy, burning, evidence of somato-visceral effects

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