OMT for LBP Samuel A. Yoakum, DO, MS, FAAPMR Tennessee Orthopaedic Clinics: TOC Spine Knoxville, TN.

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OMT for LBP Samuel A. Yoakum, DO, MS, FAAPMR Tennessee Orthopaedic Clinics: TOC Spine Knoxville, TN

Transcript of OMT for LBP Samuel A. Yoakum, DO, MS, FAAPMR Tennessee Orthopaedic Clinics: TOC Spine Knoxville, TN.

OMT for LBP

Samuel A. Yoakum, DO, MS, FAAPMR

Tennessee Orthopaedic Clinics: TOC SpineKnoxville, TN

Disclosures

none

Outline

BackgroundDefinitionsDiagnosisTechniques

Manual therapy

● Acupressure● Bodywork● Bowen technique● Chiropractic● Craniosacral therapy● Indian head massage● Lomilomi● Manual lymphatic drainage● Massage therapy● Naprapathy● Osteopathic medicine● Physical therapy● Rolfing structural integration● Shiatsu● Thai massage● Tui na● Watsu

Osteopathic Medicine

Definitions:

•Osteopathy = Osteopathic medicine

•Osteopathic manipulative medicine = OMM

•Osteopathic manipulative treatment/techniques = OMT

•Doctor of Osteopathic Medicine = DO

According to the World Osteopathic Health Organization, Osteopathy is a“…system of healthcare which relies on manual contact for diagnosis and treatment. It respects the relationship of body, mind and spirit in health and disease; it lays emphasis on the structural and functional integrity of the body and the body's intrinsic tendency for self-healing.”

Osteopathic Medicine

Andrew Taylor Still

• Founded Osteopathy 1870’s

• Previously trained as an MD

• Lost entire family to meningitis

• Devoted to the study of anatomy and physiology

• Early Hipster

Tenets of Osteopathy

● The body is a unito Understanding this concept allows the treatment of patients as

a functional whole.

● Structure and Function are interrelatedo Still’s philosophy: “Disease is the result of anatomical

abnormalities followed by physiologic discord”

● The body possesses self-regulatory and self-healing mechanisms

● Rational treatment is based on applying these principles

Diagnosis

Somatic Dysfunction● Tissue Texture Changes

o Boggy/edematous, taught/hypertonic “knots”, ropy/fibrosed, atrophied, rigid, moist, dry

● Asymmetryo Macro and Micro

● Restriction of motion = a deeper look at ROMo Named for FREEDOM Of MOTION

o Restricted motion is the BARRIER

● tendernesso Tenderpoints vs. Triggerpoints

Tissue Texture Changes

● Acuteo Edematous

o Erythematous

o Boggy

o Slick, sweaty

● Chronico Flat

o Cool

o Leathery, low tone

o Flaccid, ropy, fibrotic

Asymmetry

● Group curvature● Single segment disfunction● Compare Side-to-side

● Mastoid

● Acromion

● Lower ribs

● Iliac crests

● Greater trochanters

● Lateral femoral condyles

● Lateral malleoli

Restriction of motion

Alignment vs Restriction- everyone has some asymmetries- sometimes it points to dysfunction- sometimes it is normal

Symmetry is less of a goal than improving restriction

The Barrier Concept

● BARRIER stops motion

● FREEDOM Of MOTION is opposite the barrier

● Barriers

o Anatomical

o Physiological

o Restrictive

Anatomical & Physiological Barriers

So what is wrong?

Assessment and Diagnosis- Observe gait- Structural exam: standing, seated- Axial spine exam- Extremities

- Tenderness and Tissue Texture change are homing beacons

- Asymmetry sets the stage- Restriction of motion answers the question

Common LBP Problems

Diagnosis- Soft tissue injury- Myofascial strain / tenderpoints- Muscular: iliopsoas, QL, paraspinals,

hamstrings, piriformis, gluts, multifidi- Malrotated Sacrum and/or Ilium- Lumbar Segmental restriction

Key: Know What You Are Treating

● Soft tissue – skin, adipose, superficial fascia

● Deep Fascia – layers, lines, planes, strain patterns

● Muscle – follow the fibers

● Joint – vertebral segments, articulations, syndesmoses

Know how you are treating

● Direct Techniqueso Engage (go into) the dysfunctional barrier

o Goal is moving through the barrier to restore normal motion

● Indirect Techniqueso Disengage (go away from) the barrier

o Using the path of least resistance● Combined Techniques

o Begin indirect, then go direct

OMT

● Soft tissue mobilization / Articulatory Techniqueso Direct

● Myofascial Release (MFR)o Direct or Indirect

● Muscle Energy (contract-relax)o Direct

● Jones Counterstrain & FPRo Indirect

● High Velocity Low Amplitude (HVLA)o Direct

● Craniosacralo Direct or Indirect

Soft Tissue Mobilization

High Yield Targets:

Lumbar paraspinals, T-L junction, flank

● Allows treatment to other parts of the body to be more effective.

● Gently and directly applying pressure through the soft tissue layers: skin, fascia, adipose, muscle.

● Deep articulation, in contrast, engages joint motion

Myofascial Release (MFR)

High Yield Targets:Fascial restrictionsTL junction, iliolumbar ligament, sacral

● MFR is an umbrella term encompassing several types of osteopathic manipulative techniques (OMT) that stretch and release muscle and fascia restrictions.

● MFR first involves palpating a restriction in the fascia/soft tissue.

● Direct MFR = practitioner engages the restrictive barrier and holds until a release is felt in the tissue.

● Indirect MFR = practitioner moves the myofascial structures away from the restrictive barrier.

Counterstrain

High Yield Targets:TenderpointsIliolumbar ligament, piriformis, hamstring

lumbar and sacral TP

What is a tenderpoint?● Tenderpoints are small tense edematous areas of

tenderness typically located near tendon attachments, ligaments, or in the belly of some muscles.

Counterstrain

● Jones Counterstrain = passive indirect techniqueo Muscle being treated is positioned at a point of balance

or ease, away from the restrictive barrier.o “Fold and hold” for 90 sec

● This is a neurosensory approach to the treatment of tenderpoints.

If you can put it into a position of comfort, you can probably treat it with counterstrain

Facilitated Positional Release (FPR)

High Yield Targets:SI-joint fascia, piriformis, lumbosacral

junction

● Indirect technique● Set up is similar to counterstrain● Add activating force (compression or distraction)● Takes 3-4 seconds to induce a release

Great techniques for spine and joint dysfunctions

Muscle Energy

High Yield Targets:Iliopsoas, hamstring, quad, piriformisanterior/posterior ilium, sacral torsion

lumbar segmental dysfunction● Muscle energy ~ “contract-relax”● Direct technique

o Barrier engagedo Patient contracts against holding forceo Relax, muscle lengthenso Engage a new barriero Repeat

High Velocity, low amplitude

High Yield Targets:Anterior/Posterior sacrum or Ilium

Lumbar segmental dysfunction● Confronts restricted articulations “head on”● Don’t try it if you don’t know how● Barrier is engaged, fine-tuned in multiple planes

to minute specificity● Final thrust in nearly ALL cases should be quick

(high velocity) but short (low amplitude)

● “shotgun” techniques are discouraged● Don’t do it if you don’t know how