Osteopathic Manipulation Background and Indications Harmon, DO.pdf · Osteopathic Manipulation...

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Osteopathic Manipulation Background 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

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

Disclosure

I have no financial relationships to disclose.

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

To find health should be the goal of every physician, anyone can find

disease.

A.T.Still

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

Viscerosomatic Reflexes

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

To find health should be the goal of every physician…..

(anyone can find disease.)

A.T.Still

When Does Osteopathic Treatment Apply to Your Patient?

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

Sub-Occipital Release

Sinus Congestion

Consider

Sinus Effluage (maxillary and frontal)

Cranial Sacral

Soft Tissue

Suboccipital release

Carpel Tunnel Syndrome

• Stretch techniques

Pregnancy Related Pain

Pneumonia

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

Questions?

Questions?

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