SCS FAMILY MEDICINE Introduction in Osteopathic Principles & Initial Osteopathic Evaluation for Low Back Pain

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1 SCS FAMILY MEDICINE Introduction in Osteopathic Principles & Initial Osteopathic Evaluation for Low Back Pain CATHERINE DONAHUE D.O. ASSISTANT PROFESSOR DEPARTMENT OF OMM MSUCOM

2 WHAT WE WILL COVER Osteopathic History What is Somatic Dysfunction? The Structure and Function Relation What is OMT? How to start LBP evaluation and screen for Somatic Dysfunction When to Refer and How

3 WHAT IS OSTEOPATHY? Founded by a M.D., Dr. Andrew Taylor Still in 1874 Currently 39 Schools over 3,000 graduates each year Tenets of Osteopathic Medicine 1. The body is a unit; the person is a unit of body, mind, and spirit. 2. The body is capable of self-regulation, self-healing, and health maintenance. 3. Structure and function are reciprocally interrelated. 4. Rational treatment is based upon an understanding of the basic principles of body unity, self-regulation, and the interrelationship of structure and function.

4 FIRST SCHOOL First School in 1892 Kirksville, MO First Class 18 Students By Students

5 MSU COLLEGE OF OSTEOPATHIC MEDICINE Started in 1969 (MCOM) Moved to MSU in 1971 First Public COM Over 3500 Graduates

6 WHAT ARE MANUAL MODALITIES? Hands-On Approach to Improving the Body s Function Osteopathic Manipulative Treatment Physical Therapy Chiropractic Care Massage Therapy Yoga Therapy Rolfing Feldenkrais Method Cranio-Sacral Therapy Graston Technique Many More.

7 MEDICAL FIELDS FOR MSK PROBLEMS Primary Osteopathic Neuromusculoskeletal Medicine Specialize in the Neurologically Intact Patients Manual Medicine Orthopedics Trained Primarily in Surgical Repair Physical Medicine & Rehabilitation Focused on Neurologically Impaired Patients Neurology Primarily Headaches Fellowship Non-Surgical Sports Medicine More Extremities and Injuries Not necessarily Manual Medicine

8 OSTEOPATHIC NOMENCLATURE OMT = Osteopathic Manipulative TREATMENT (Not Therapy) hands-on care. It involves using the hands to diagnose, treat, and prevent illness or injury. Using OMT, your osteopathic physician will move your muscles and joints using techniques including stretching, gentle pressure and resistance. OMM = Osteopathic Manipulative Medicine The study, integration and application of OMT Somatic Dysfunction Impaired or altered function of related components of the somatic (body framework) system: skeletal, arthrodial and myofascial structures, and their related vascular, lymphatic, and neural elements.

9 6 OSTEOPATHIC APPROACHES Biomechanical Neurological Respiratory/Circulatory Metabolic-Energy Biopsychosocial Organ Systems

10 SOMATIC DYSFUNCTION Diagnostic Objective Triad ART(T) Asymmetry R vs. L Restriction in Range of Motion Limited Movement Tissue Texture Abnormality Palpation (T)enderness Subjective

11 MSK EXAM Detects loss of function There is often structural pathology that relates to the functional loss Structural AND Functional pathology both need to be evaluated and treated. Somatic Dysfunction does not mean cause of pain, but is relevant in pattern of clinical presentation Compare normal, physiologic MSK function to dysfunctional MSK pattern

12 MUSCULOSKELETAL BARRIERS Joint Restriction Muscle Tightness Fascial Strain Soft Tissue Congestion Ligamentous Bind

13 PALPATION EXERCISE Skin Tissue Scan Find TTA * 4 th layer hypertonicity in presence of joint dysfunction

14 ROM EXERCISE Forearm Supination/Pronation

15 STRUCTURE AND FUNCTION

16 *** GOAL OF MANUAL MEDICINE *** NOT treating pain but OBJECTIVE loss of function Restoring pain-free maximal motion to the neuromusculoskeletal system in postural balance Optimize reflexive behavior

17 WHAT IS OMT? Hands on care It involves using the hands to diagnose, treat, and prevent illness or injury.

18 TYPES OF OMT Muscle Energy Myofascial Release Balanced Ligamentous Tension Osteopathy in the Cranial Field High Velocity/Low Amplitude Still Technique Fascial Distortion Model Strain/Counterstrain Ligamentous Articular Strain

19 WHEN TO USE OMT? Is the functional issue due to structure? Is the patient neurologically intact? Common Reasons: Back Pain Neck Pain Headaches (Migraine, Ear infections, Sinus Issues, etc.) Extremity Pain (Carpal Tunnel Syndrome, Plantar Fasciitis, etc.) Respiratory Issues (Asthma, Pneumonia, COPD, etc.) Abdominal Pain (IBS, Constipation, etc.) Newborn (Feeding Difficulty, Colic, Plageiocephaly, etc.) WELLNESS

20 INITIAL LOW BACK PAIN EVALUATION History and ROS Is there any red flags? Objective NMSK Exam Is patient neurologically intact? Is there a loss of function? Is there a structural component?

21 RED FLAGS TO CONSIDER Age < 18 years or > 50 Bowel or Bladder Incontinence Weight loss History of cancer (personal or familial) History of severe trauma Fever, night sweats Progressive motor weakness or numbness Night pain that awakens patient

22 OBJECTIVE STRUCTURAL EXAM Observe How do they move through space? - Gait, Transitions, Posture Palpate Tissue Texture Scan Find TTA, Barriers (Joint, Muscle, Ligament, Fascia ) Motion Test Passive Sidebending- look at neutral vertebral mechanics Backward bending- facet loading Standing Flexion Test- Pelvic girdle dysfunctions, spinal curvature Stork Test- Sacroiliac Joint restrictions Seated Flexion Test- Sacroiliac Joint restrictions

23 ASSESSMENT & PLAN Diagnose Somatic Dysfunction Record specific Objective diagnosis (ie. L5 FRS Right) in Physical Exam Record Somatic Dysfunction body region in Assessment portion (10 body regions) Plan Further imaging/evaluation warranted? Treat relevant somatic dysfunctions Prescribe homework: home exercises, lifestyle modifications Follow up? Other manual modalities?

24 WHEN TO REFER? Do you feel you can do it? Are you considering Physical Therapy or other Hands-On Approach?

25 WHERE TO FIND OMM PHYSICIANS Contact a Local College of Osteopathic Medicine American Academy of Osteopathy

26 SUGGESTED READINGS Principles of Manual Medicine. Phillip Greenman DO Foundations for Osteopathic Medicine. Anthony Chila DO 2010 Somatic Dysfunction in Osteopathic Family Practice. Kenneth Nelson 2014 Philosophy of Osteopathy. Andrew Taylor Still 1899

27 BIBLIOGRAPHY A Brief History of Osteopathic Medicine. March 3, History of MSU Osteopathic Medical Specialties. March 3, 2018

28 MSU COM STATEWIDE CAMPUS SYSTEM

29 MSU COM STATEWIDE CAMPUS SYSTEM The Statewide Campus System will unite the resources of MSUCOM, academic members, and member health care institutions to support quality osteopathic educational programs responsive to the healthcare needs of Michigan and be in compliance with state and federal regulations and accreditation standards of the American Osteopathic Association. Oversees 20 Different Groups Calendar of Events -