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Transcript of Osteopathic Manipulation Background and Indications Harmon, DO.pdf · Osteopathic Manipulation...
Osteopathic ManipulationBackground and Indications
Kelley Harmon, D.O.Maine Dartmouth Family Medicine Residency
MaineGeneral Medical Center
Augusta, Maine
Regional Assist. Dean, University of New England COM
Adjunct Assistant Professor Geisel School of Medicine at Dartmouth Assistant Clinical Professor, Tufts School of Medicine
February 9, 2018
OBJECTIVES
-Introduction to the Tenets of Osteopathy
-Understand Osteopathic Terminology you may see in Consultations
-Discuss Indications for OMT
-Review Treatments for Common Patient Presentations
What is Osteopathy?
Application of the physician’s hands on a patient to help maximize the body’s normal function.
(Theory: movement of fluids, relaxation of tissues, influence of neurologic input)
Why Should We Understand Osteopathy?
• Patient centered care
• Augmentation of other treatment modalities
• Increased palpatory understanding of pain/origin of pain
• Increasing numbers of trainees
The Osteopathic Approach
-Tenets of Osteopathy
-Allopathic and Osteopathic differences (and similarities)
Holistic approach
Educating patients
Training requirements
-When does osteopathy apply to your patient?
Osteopathic Manipulative Medicine
A system of medical care with a philosophy that combines the needs of the patient with current practice of medicine, surgery and obstetrics, and emphasis on the interrelationships between structure and function, and an appreciation of the body’s ability to heal itself.
• The human being is a dynamic unit of function.
• The body possesses self regulatory mechanisms.
• Structure and function are interrelated at all levels
• Rational treatment is based on these principles.
Tenets of Osteopathic Medicine:
Somatic Dysfunction
• Definition:
– Impaired or altered function of related components of the somatic (body framework) system: skeletal, arthrodial, and myofascial structures, and related vascular, lymphatic and neural elements
Somatic Dysfunction
• Diagnosis:
• Tissue texture changes
• Asymmetry of structure
• Restriction of motion
• Tenderness of palpation
Somatic Dysfunction
Visceral Dysfunction
Spinal Facilitation
Afferent Drive
Muscle
Tone Visceral and
Vascular Tone
Perception
Well-BeingHormonal
Adaptation
Palpation-Identifying Somatic Dysfunction
Head
Cervical Spine
Thoracic Spine
Lumbar Spine
Ribs
Abdomen
Pelvic
Sacrum
Upper Extremities
Lower Extremities
General modalities of osteopathic manipulation
• Soft Tissue and Myofascial Release• Articulatory techniques• Strain-Counterstrain• Muscle Energy (ME)• High Velocity Low Amplitude/Thrust (HVLA)• Lymphatic techniques• Facilitated Positional Release (FPR)• Balanced Ligamentous Tension (BLT)• Cranial Osteopathy
Goals of manipulative treatment
• Resolution of primary and secondary somatic dysfunction
• Improvement of homeostatic mechanisms
– Respiratory
– Circulatory
– Immune
• Reduction of inappropriate afferent neural stimuli
Be an observer.
Palpatory findings
Gait disturbance
Postural issues
Any pain symptomology that can be connected to objective findings
Osteopathic Structural Examination
• Patient examined in two positions
• Documentation at least one of the following elements:
– Tissue texture changes
– Asymmetry of landmarks
– Range of Motion alterations
– Tenderness on palpation (per patient)
Is Osteopathy the First Approach to Treatment of all Complaints?
No.
Osteopathy should be intertwined in theory in the approach to the patient, and manual
techniques applied at appropriate times and settings.
i.e. Don’t ignore red flag symptoms or other standards of care .
Common Patient Presentations That Could Benefit From OMT
Headache
URI-Sinus Congestion
Carpel Tunnel
Pregnancy Related Pain (LBP, pelvic pain)
Pneumonia
Musculoskeletal Pain
Headache• Consider:
– Subocciptial Release
– Strain Counterstrain (A1C)
– Cranial Sacral
– Trapezius and cervical paraspinal soft tissue
Sinus Congestion
Consider
Sinus Effluage (maxillary and frontal)
Cranial Sacral
Soft Tissue
Suboccipital release
OMT for Pulmonary Disease– Pneumonia
• Rib raising to increase rib motion and normalize sympathetic tone
• Lymphatic techniques to decrease congestion
• Address thoracic and sternal restrictions to decrease the work required to breathe
• OA and AA release, and cervical spine somatic dysfunction correction to normalize parasympathetic tone via vagusnerve
*Decreased length of stay 10% in patients with Pneumonia
Musculoskeletal Pain
Examples:
Back Pain
Neck Pain
Specific body area following trauma
Consider Soft Tissue, HVLA, Strain Counterstrain, Attend to Iliopsoas and Pelvis with lumbar complaints.
Other Special Populations
Geriatrics
– Soft tissue, counterstrain
Down Syndrome
*never high velocity techniques-c-spine risk
Pediatrics
– Breast feeding difficulty
– Childhood constipation
– Sports Injuries
Resources
• http://www.osteopathic.org/osteopathic-health/treatment/Pages/default.aspx
• http://www.academyofosteopathy.org/
• http://www.mainedartmouth.org/
• Treatment Guidelines Low Back Pain: http://www.healthquality.va.gov/low_back_pain/annals_2007_guideline.pdf
References• Modi RG, Shah NA, Clinical Anatomy and Osteopathic Manipulative Medicine, Lippincott, Williams and Wilkins, 2005• Nelson KE, Glonek T, Somatic Dysfunction in Osteopathic Family Medicine, Lippincott Williams and Wilkins,2007• Noll Dr, Shores JH, Gamber RG, Slocum DC, The efficacy of adjunctive OMT in the elderly hospitalized with
pneumonia. JAOA, 1998; 98:389• Radjiewski TM, Lumley MM, Cantieri, MS, Effect of OMT on length of stay for pancreatitis: a randomized pilot study.
JAOA 1998; 98:264-272• Shubrook and Dooley, Effects of a structured curriculum in osteopathic manipulative treatment (OMT) on
osteopathic structural examinations and use of OMT for hospitalized patients, JAOA, Vol. 100, No 9, September 2000• Sleszynski SL, Kelso AF, Comparison of thoracic manipulation with incentive spirometry in preventing postoperative
atelectasis, JAOA 1993; 93:834-845• Ward RC, Ferome FA, Jones JM, Kappler RE, Kelso AF, Kuchera JL, et al. Foundations for Osteopathic Medicine.
Maltimore, Md: Williams & Wilkins, 1997• http://www.healthquality.va.gov/low_back_pain/annals_2007_guideline.pdf
• http://www.chirobase.org/07Strategy/AHCPR/ahcprclinician.html• http://www.osteopathic.org/osteopathic-health/treatment/Pages/default.aspx• http://www.academyofosteopathy.org/• http://www.mainedartmouth.org/• http://jaoa.org/article.aspx?articleid=2094358#72999288