Osteopathic Manipulation Background and Indications

Transcription

1 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

2 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

3 Disclosure I have no financial relationships to disclose.

4 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)

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6 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

7 To find health should be the goal of every physician, anyone can find disease. A.T.Still

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9 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?

10 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.

11 Tenets of Osteopathic Medicine: 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.

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13 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

14 Somatic Dysfunction Diagnosis: Tissue texture changes Asymmetry of structure Restriction of motion Tenderness of palpation

15 Viscerosomatic Reflexes

16 Somatic Dysfunction Visceral Dysfunction Afferent Drive Spinal Facilitation Muscle Tone Visceral and Vascular Tone Perception Well-Being Hormonal Adaptation

17 Palpation- Identifying Somatic Dysfunction Head Cervical Spine Thoracic Spine Lumbar Spine Ribs Abdomen Pelvic Sacrum Upper Extremities Lower Extremities

18 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

19 Goals of manipulative treatment Resolution of primary and secondary somatic dysfunction Improvement of homeostatic mechanisms Respiratory Circulatory Immune Reduction of inappropriate afferent neural stimuli

20 To find health should be the goal of every physician.. (anyone can find disease.) A.T.Still

21 When Does Osteopathic Treatment Apply to Your Patient?

22 Be an observer. Palpatory findings Gait disturbance Postural issues Any pain symptomology that can be connected to objective findings

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24 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)

25 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.

26 Common Patient Presentations That Could Benefit From OMT Headache URI-Sinus Congestion Carpel Tunnel Pregnancy Related Pain (LBP, pelvic pain) Pneumonia Musculoskeletal Pain

27 Consider: Headache Subocciptial Release Strain Counterstrain (A1C) Cranial Sacral Trapezius and cervical paraspinal soft tissue

28 Sub-Occipital Release

29 Sinus Congestion Consider Sinus Effluage (maxillary and frontal) Cranial Sacral Soft Tissue Suboccipital release

30 Carpel Tunnel Syndrome Stretch techniques

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34 Pregnancy Related Pain

35 Pneumonia

36 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 vagus nerve *Decreased length of stay 10% in patients with Pneumonia

37 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.

38 Other Special Populations Geriatrics Soft tissue, counterstrain Down Syndrome *never high velocity techniques-c-spine risk Pediatrics Breast feeding difficulty Childhood constipation Sports Injuries

39 Resources Treatment Guidelines Low Back Pain: ain/annals_2007_guideline.pdf

40 Questions?

41 Questions?

42 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: 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: Ward RC, Ferome FA, Jones JM, Kappler RE, Kelso AF, Kuchera JL, et al. Foundations for Osteopathic Medicine. Maltimore, Md: Williams & Wilkins,