Where OMM sources disagree

Muscle energy for left on left#

Applies to: Left on left

No consensusMuscle energy for left on left: Greenman also treats this torsion with the patient on the right side, chest up. Board review uses the Sims method asked here, on the side of the axis (left), chest down.

Muscle energy for right on right#

Applies to: Right on right

No consensusMuscle energy for right on right: Greenman also treats this torsion with the patient on the left side, chest up. Board review uses the Sims method asked here, on the side of the axis (right), chest down.

Sources label the sphinx test differently here#

Applies to: Every unilateral sacral flexion and extension case

No consensusSources label the sphinx test differently here: some call it "positive", others "negative". This trainer only describes what the sulci do.

L5 with a left on left torsion#

Board answer (what we key)

Neutral (Type I), sidebent left, rotated right

Also accepted

Non-neutral (Type II), sidebent right, rotated right

No consensusSome osteopathic school teaching (MSU, in the Greenman tradition) pairs a left on left torsion with an extended, non-neutral L5 (ERS right). Board review pairs it with a neutral L5, and the ERS pattern is never offered as a wrong answer here.

L5 with a right on right torsion#

Board answer (what we key)

Neutral (Type I), sidebent right, rotated left

Also accepted

Non-neutral (Type II), sidebent left, rotated left

No consensusSome osteopathic school teaching (MSU, in the Greenman tradition) pairs a right on right torsion with an extended, non-neutral L5 (ERS left). Board review pairs it with a neutral L5, and the ERS pattern is never offered as a wrong answer here.

L5 with a left on right torsion#

Board answer (what we key)

Non-neutral (Type II), sidebent right, rotated right

No consensusBoard review usually describes this L5 as flexed (L5 F RR SR). Some charts leave flexion or extension unstated, so test it rather than assume.

L5 with a right on left torsion#

Board answer (what we key)

Non-neutral (Type II), sidebent left, rotated left

No consensusBoard review usually describes this L5 as flexed (L5 F RL SL). Some charts leave flexion or extension unstated, so test it rather than assume.

Seated flexion test#

Applies to: Every innominate dysfunction case

No consensusSeated flexion test: board review treats it as negative in innominate dysfunction (used here); some school handouts say it can be positive on the same side.

Pubic tubercle#

Applies to: Superior innominate shear and inferior innominate shear, both sides

No consensusPubic tubercle: Mitchell's model moves it with the shear; other sources leave it out. Not tested here.

Rule of threes at T10 to T12#

Board answer (what we key)

T10 a full level down, T11 halfway, T12 level with its own transverse processes

Also accepted

T10 to T12 each level with its own transverse processes (Greenman)

No consensusGreenman groups T10 to T12 together, each spinous tip level with its own transverse processes. Board review and the Foundations glossary use the rule of threes asked here: T10 a full level down, T11 halfway, T12 level.

Lumbar superior facet orientation#

Board answer (what we key)

Backward and medially (BM)

Also accepted

Backward, upward and medially (BUM), as Foundations writes it

No consensusLumbar superior facets: board review and Greenman describe them as backward and medially (BM); Foundations writes backward, upward and medially (BUM). BUM is never marked wrong here.

Muscle energy for exhaled rib 2#

Board answer (what we key)

Posterior scalene

Also accepted

Anterior and middle scalenes

No consensusRib 2: board review uses the posterior scalene; some course handouts add the middle scalene and StatPearls names the scalenes for ribs 1 and 2, so the anterior and middle scalenes are never marked wrong for rib 2.

Muscle energy for exhaled rib 9#

Board answer (what we key)

Latissimus dorsi

Also accepted

Serratus anterior

Muscle energy for exhaled ribs 11 and 12#

Board answer (what we key)

Quadratus lumborum

Also accepted

Latissimus dorsi

No consensusRibs 11 and 12: board review keys the quadratus lumborum; StatPearls uses the latissimus dorsi for both, and some maps use it for rib 11 only.

Head and neck#

Board answer (what we key)

Sympathetic T1-T4

Also accepted

Sympathetic T1-T5

No consensusHead and neck: T1-T4 in board review (used here); some sources give T1-T5.

Heart#

Board answer (what we key)

Sympathetic T1-T5

Also accepted

Sympathetic T1-T4; Sympathetic T1-T6

No consensusHeart: T1-T5 in board review (used here); some anatomy texts and study decks give T1-T4, and some lecture slides T1-T6.

Lungs and bronchi#

Board answer (what we key)

Sympathetic T2-T7

Also accepted

Sympathetic T1-T6; Sympathetic T2-T6

No consensusLungs: T2-T7 in board review (used here); StatPearls gives T1-T6 and some charts T2-T6.

Esophagus#

Board answer (what we key)

Sympathetic T2-T8

Also accepted

Sympathetic T3-T6; Sympathetic T1-T6

No consensusEsophagus: T2-T8 in board review (used here); other sources give T3-T6 or T1-T6.

Stomach and gallbladder#

Board answer (what we key)

Sympathetic T5-T9

Also accepted

Sympathetic T5-T10

No consensusUpper GI: T5-T9 in board review (used here); some Kuchera-based lecture notes give T5-T10.

Liver#

Board answer (what we key)

Sympathetic T5-T9

Also accepted

Sympathetic T5-T10; Sympathetic T6-T11

No consensusUpper GI: T5-T9 in board review (used here); some Kuchera-based lecture notes give T5-T10.

No consensusLiver and pancreas: Foundations gives about T6 through T9 to T11, so T10 and T11 are never marked wrong here.

Spleen#

No consensusSpleen: OMM tables list vagal parasympathetic supply, but direct parasympathetic innervation of the human spleen is disputed. Not tested here.

Pancreas#

Board answer (what we key)

Sympathetic T5-T9

Also accepted

Sympathetic T6-T11

No consensusLiver and pancreas: Foundations gives about T6 through T9 to T11, so T10 and T11 are never marked wrong here.

No consensusPancreas: some sources put part of its supply through the superior mesenteric ganglion, and laterality is taught both ways (head right, body and tail left). Neither is tested here.

Jejunum and ileum; cecum, ascending colon and proximal two thirds of the transverse colon#

Board answer (what we key)

Sympathetic T10-T11

Also accepted

Sympathetic T8-T11

No consensusMiddle GI: T10-T11 in board review (used here); some Kuchera-based lecture notes give T8-T11.

Appendix#

Board answer (what we key)

Sympathetic T12

Also accepted

Sympathetic T10-T12; Sympathetic T10-T11

No consensusAppendix: T12 in board review (used here); other sources give T10-T12 or group it with the ascending colon at T10-T11. Some references describe mainly right-sided findings; laterality is not tested here.

Kidneys#

Board answer (what we key)

Sympathetic T10-T11

Also accepted

Sympathetic T10-L1; Sympathetic T8-L1

No consensusKidneys: T10-T11 in board review (used here); other charts give T10-L1 and anatomy texts T8-L1.

Kidneys: parasympathetic supply#

Board answer (what we key)

Vagus nerve

Also accepted

Pelvic splanchnic nerves (S2-S4)

No consensusKidneys: the vagus is the OMM convention used here; some tables give the pelvic splanchnic nerves, so those are never marked wrong, and direct renal parasympathetic anatomy is still debated.

Adrenal medulla#

Board answer (what we key)

Sympathetic T10

Also accepted

Sympathetic T8-T10; Sympathetic T5-T10; Sympathetic T10-L1; Sympathetic T8-L1

No consensusAdrenal medulla: T10 in board review (used here); other charts give T8-T10 or T5-T10, and anatomy texts up to L1.

Upper ureter#

Board answer (what we key)

Sympathetic T10-T11

Also accepted

Sympathetic T10-L1

No consensusUpper ureter: T10-T11 in board review (used here); anatomy texts give about T10-L1.

Upper ureter: parasympathetic supply#

Board answer (what we key)

Vagus nerve

Also accepted

Pelvic splanchnic nerves (S2-S4)

No consensusUpper ureter: the vagus is the OMM convention used here; some tables give the pelvic splanchnic nerves, so those are never marked wrong, and direct parasympathetic anatomy is still debated.

Lower ureter#

Board answer (what we key)

Sympathetic T12-L1

Also accepted

Sympathetic T12-L2

No consensusLower ureter: T12-L1 in board review (used here); some decks give T12-L2.

Bladder#

Board answer (what we key)

Sympathetic T11-L2

Also accepted

Sympathetic T10-L2; Sympathetic T10-L1

No consensusBladder: T11-L2 in board review (used here); other sources give T10-L2 or T10-L1.

Ovaries and testes#

No consensusGonads: sources differ on parasympathetic supply (the vagus or the pelvic splanchnic nerves, S2-S4). Not tested here.

Uterus and cervix#

Board answer (what we key)

Sympathetic T10-L2

Also accepted

Sympathetic T10-T12; Sympathetic T9-L2

No consensusUterus: T10-L2 in board review (used here); other sources give T10-T12 or T9-L2.

Prostate#

Board answer (what we key)

Sympathetic T12-L2

Also accepted

Sympathetic T11-L2; Sympathetic L1-L2

No consensusProstate: T12-L2 in board review (used here); other sources give T11-L2 or L1-L2.

Upper extremity#

Board answer (what we key)

Sympathetic T2-T8

Also accepted

Sympathetic T2-T7; Sympathetic T2-T6

No consensusUpper extremity: T2-T8 in board review (used here); other charts give T2-T7 or T2-T6.

Lower extremity#

Board answer (what we key)

Sympathetic T11-L2

Also accepted

Sympathetic T10-L2

No consensusLower extremity: T11-L2 in board review (used here); other charts give T10-L2, and Foundations gives T10 to L2 or L3 for the leg's blood vessels.

Liver#

Board answer (what we key)

Right fifth and sixth intercostal spaces

Also accepted

Right seventh intercostal space

No consensusSome charts (AMBOSS among them) extend the liver point down to the right seventh intercostal space; board review usually keys the fifth and sixth.

Gallbladder#

Board answer (what we key)

Right sixth intercostal space

No consensusSome references (StatPearls among them) put the gallbladder point in the right fifth intercostal space; board review usually keys the sixth.

Stomach acidity#

Board answer (what we key)

Left fifth intercostal space

No consensusSome charts give the stomach one point across the left fifth and sixth spaces instead of separate acidity and peristalsis points.

Stomach peristalsis#

Board answer (what we key)

Left sixth intercostal space

No consensusSome charts give the stomach one point across the left fifth and sixth spaces instead of separate acidity and peristalsis points.

Adrenal#

Board answer (what we key)

About 1 inch lateral and 2 inches above the umbilicus

No consensusCharts differ slightly on the exact distances once their units are converted (1 inch is about 2.5 cm); in the usual charts the adrenal point sits above the kidney point.

Kidney#

Board answer (what we key)

About 1 inch lateral and 1 inch above the umbilicus

No consensusCharts differ slightly on the exact distances once their units are converted (1 inch is about 2.5 cm); in the usual charts the adrenal point sits above the kidney point.

AC1#

Board answer (what we key)

Rotation away from the point

Also accepted

Flexion, sidebend away, rotate away (F Sa Ra)

No consensusAC1: most sources rotate the head away; StatPearls and one institutional handout add sidebending away (Sa Ra). Foundations adds slight flexion and sidebending away (F Sa Ra).

AC2 to AC6#

Board answer (what we key)

Flexion, sidebend away, rotate away (F Sa Ra)

Also accepted

Extension, sidebend away, rotate away (E Sa Ra)

No consensusOne recent institutional handout treats AC3 in extension (E Sa Ra); flexion is the board answer for AC2 to AC6.

AC7#

Board answer (what we key)

Flexion, sidebend toward, rotate away (F St Ra)

Also accepted

Flexion, sidebend away, rotate away (F Sa Ra)

No consensusAC7: board review sidebends toward the point (F St Ra); StatPearls uses one setup, F Sa Ra, for all anterior cervical points. Neither is marked wrong here.

PC3 midline#

Board answer (what we key)

Flexion, sidebend away, rotate away (F Sa Ra)

No consensusPC3 midline: the standard review texts use flexion; a recent institutional handout lists extension as standard and flexion as the alternative. Flexion is the board answer.

PC4 to PC8 midline#

Board answer (what we key)

Extension, sidebend away, rotate away (E Sa Ra)

Also accepted

Flexion, sidebend away, rotate away (F Sa Ra)

No consensusPC4 to PC8 midline: most sources use extension (E Sa Ra); one review source lists flexion (F Sa Ra). Neither is marked wrong here.

AT7, AT8 and AT9#

Board answer (what we key)

Flexion, sidebend toward, rotate away (F St Ra)

Also accepted

Flexion; Flexion, sidebend toward, rotate toward (F St Rt); Flexion, sidebend away, rotate away (F Sa Ra)

No consensusThese rotations describe the trunk. Setups that move the knees toward the point rotate the trunk away from it, so some handouts describe the same position by the knees.

No consensusSome review texts sidebend the lower anterior thoracic points away (F Sa Ra); most sources sidebend toward, and neither is marked wrong here.

AT10, AT11 and AT12#

Board answer (what we key)

Flexion, sidebend toward, rotate away (F St Ra)

Also accepted

Flexion, sidebend toward, rotate toward (F St Rt); Flexion, sidebend away, rotate away (F Sa Ra)

No consensusThese rotations describe the trunk. Setups that move the knees toward the point rotate the trunk away from it, so some handouts describe the same position by the knees.

No consensusSome review texts sidebend the lower anterior thoracic points away (F Sa Ra); most sources sidebend toward, and neither is marked wrong here.

AR1, AR2 and AR3 to AR10#

Board answer (what we key)

Flexion, sidebend toward, rotate toward (F St Rt)

Also accepted

Flexion, sidebend toward, rotate away (F St Ra)

No consensusAnterior rib points: most sources rotate toward the point (F St Rt); one board review card rotates away (F St Ra). Neither is marked wrong here.

How long to hold a rib tender point#

Board answer (what we key)

120 seconds

No consensusMany sources use about 90 seconds for every point, ribs included; board review keys 120 seconds for rib tender points.

Barrier from somatic dysfunction#

Board answer (what we key)

Restrictive barrier

Also accepted

Pathologic barrier

No consensusMost sources call this the restrictive barrier; some review texts call it a pathologic barrier, while the AACOM glossary keeps pathologic for structural tissue change.

FPR facilitating force#

Board answer (what we key)

Compression, torsion or both

Also accepted

Traction

No consensusStatPearls also lists traction as a facilitating force; classic review names compression and torsion.

Cobb angle that defines scoliosis#

Board answer (what we key)

10 degrees

No consensusFoundations (2011) uses an older postural definition, a curve of more than 5 degrees. The current definition and board review use 10 degrees.

Moderate curve in a growing child#

Board answer (what we key)

Bracing

No consensusThe exact bracing window varies a little between sources (upper limit 40, 45 or 50 degrees), but 32 degrees falls inside all of them.

Schober result#

Board answer (what we key)

Restricted lumbar flexion

No consensusCutoffs differ: Foundations uses about 5 cm in one chapter and calls a gain under 4 cm restricted in another. This case (a 2 cm gain) is abnormal under both.

Snuffbox tenderness#

Board answer (what we key)

Avascular necrosis of the proximal scaphoid

Also accepted

Scaphoid nonunion

Resisted flexion, palm up#

Board answer (what we key)

Long head biceps tendinopathy

Also accepted

Superior labral (SLAP) lesion

Direct treatment of the fibular head#

Board answer (what we key)

Anterolaterally

Also accepted

Anteriorly

No consensusFoot position differs by technique: the Foundations thrust adds external rotation at the ankle; Greenman's seated muscle energy sets the foot in inversion and internal rotation and has the patient evert and dorsiflex. The fibular head still goes anterolaterally.

Blow to the outside of the knee#

Board answer (what we key)

ACL, MCL and medial meniscus

Also accepted

ACL, MCL and lateral meniscus

No consensusLater arthroscopic series of acute ACL plus MCL injuries found lateral meniscal tears more often than medial ones.

Cranial rhythm rate#

Board answer (what we key)

10 to 14 cycles per minute

Also accepted

8 to 12 cycles per minute; 8 to 14 cycles per minute; 6 to 16 cycles per minute; 6 to 10 cycles per minute

No consensusPublished rates vary with source and method, from about 6 to 16 a minute, and no rate is a validated diagnostic test.

Cranial contraindication#

Board answer (what we key)

Acute intracranial hemorrhage

No consensusBoard review also calls raised intracranial pressure absolute; a 2019 JAOA technique paper lists it as relative and adds stroke as absolute.

When to avoid CV4#

Board answer (what we key)

Pregnancy, especially the third trimester

No consensusA large third-trimester OMT trial included CV4 and found no rise in precipitous labor or delivery complications, though labor ran longer in the OMT group, so the caution is traditional rather than proven.

Technique with osteoporosis#

Board answer (what we key)

Counterstrain

No consensusStatPearls lists osteoporosis as an absolute contraindication to HVLA; some osteopathic papers call it relative.

Distal colon parasympathetics#

Board answer (what we key)

Sacral rocking

No consensusGreenman's text carries the vagus to mid descending colon while his figure stops at the transverse colon; the sigmoid colon and rectum are pelvic in every source.