Integrating Osteopathic Manipulative Treatment into Clinical Care Helen
- Slides: 26
Integrating Osteopathic Manipulative Treatment into Clinical Care Helen Luce DO Marguerite Elliott DO, MS Mark Robinson DO University of Wisconsin Department of Family Medicine May 3, 2008
Welcome & Introductions n Presenters n n n Helen Luce DO Marguerite Elliott DO, MS Mark Robinson DO n Purpose of seminar n Overview of osteopathic philosophy, the use of OMT in specific clinical scenarios, and guidelines for the allopathic precepting physician.
Objectives n Describe 3 clinical situations in which OMT can be performed to augment other medical therapy and improve patients’ health. n Participate in OMT through observation or performance of 2 specific treatments. n Discuss precepting methods for allopathic physicians who supervise osteopathic residents performing OMT.
Overview n Osteopathic medicine n Osteopathic philosophy n OMT (Osteopathic Manipulative Treatment) n Overview of some common techniques
Definition n Osteopathic Medicine n A system of diagnosis and treatment that recognizes the role of the musculoskeletal system in the healthy functioning of the human body. -From the AMA Encyclopedia of Medicine
Osteopathic Philosophy n Four basic principles n n Body functions as a unit – body, mind, spirit Structure and function are interrelated Body is capable of self-regulation, self-healing, and health maintenance Rational treatment is based on understanding these principles
Somatic Dysfunction n Impaired or altered function of related components of somatic system (body framework) n n Skeletal and myofascial structures Related vascular, lymphatic, & neural elements
Palpatory Diagnosis n T: Tissue texture abnormalities n A: Asymmetry n R: Restriction of motion n T: Tenderness
Barrier Concepts n Anatomic Barrier n Physiologic Barrier n Restrictive Barrier Anatomic Physiologic Barrier Restrictive Barrier Physiologic Barrier Anatomic Barrier
Direct and Indirect Techniques n Direct Technique that engages the most restrictive barrier n Indirect n Technique that engages the least restrictive barrier n
Forces Applied in OMT n Extrinsic Supplied by physician n Intrinsic n Supplied by patient n
OMT n Includes many different techniques n Requires additional training (200 -600 hrs during med school) n Requires ongoing practice and continuing education
Safety of OMT n Low rate of complications (1 in 1 million) n Careful patient and modality selection n Most common complications n n Vertebrovascular accidents Cauda Equina syndrome n Modality most associated with complications is HVLA
Contraindications n Case-by-case basis n Fracture, dislocation, tumor, infection, and osteomyelitis are contraindications for OMT directly over that site n Conditions to consider carefully: n Down Syndrome, RA, pregnancy, strains & sprains, acute herniated disc, acute inflammatory situations, anatomic instability, hypermobility, joint prosthesis, and severe manifestations of visceral disorders
Common Techniques n HVLA n Visceral n Muscle Energy n Myofascial Release n Soft Tissue n Cranial n Counterstrain n Techniques of Still n Facilitated Positional n Balanced Ligamentous Release n Lymphatic Tension & Ligamentous Articular Strain n Articulatory
Soft Tissue Techniques n Direct technique n “Involves lateral stretching, linear stretching, deep pressure, traction, and/or separation of muscle origin and insertion while monitoring tissue response and motion changes by palpation” n Indications n ↓muscle spasm; stretch and ↑elasticity; improve circulation; ↑ venous and lymphatic drainage; promote patient relaxation n Absolute contraindications: none
Myofascial Release Techniques n Direct, indirect, or combination of both n “Designed to stretch and reflexly release patterned soft tissue and joint-related restrictions” n Indications n ↓ muscle and fascial tension; stretch and ↑ elasticity in tight tissues; improve circulation to specific region; ↑ venous and lymphatic drainage n Absolute contraindications: none
Muscle Energy Techniques n Direct technique n “system of diagnosis and treatment in which the patient voluntarily moves the body as specifically directed by the physician; from a precisely controlled position, against a defined resistance by the physician” n Indications n n 1º = Somatic dysfunction of myofascial or articular origin 2º = Improve circulation, balance neuromuscular relationships, and ↑ tone in hypotonic/weak muscles n Absolute contraindications n n Fracture, dislocation, or joint instability at treatment site Patient unable to understand instructions or uncooperative
HVLA n Direct technique n “Uses high-velocity/low-amplitude forces; also called mobilization with impulse treatment” n Indications n Somatic dysfunction of articular origin n Absolute contraindications n Joint instability; severe osteoporosis; bony metastasis, osteomyelitis, other infection, or joint replacement in the treatment area; osteoarthritic joint with ankylosis; severe herniated disc with radiculopathy; congenital anomalies; Down syndrome (esp. c-spine); RA of c-spine; achondroplastic dwarfism (c-spine)
Balanced Ligamentous & Ligamentous Articular Strain Techniques n Indirect technique n Indications n Somatic dysfunctions of articular or myofascial basis; areas of lymphatic congestion or local edema n Absolute contraindications: none
Visceral Techniques n Direct, indirect, or combined n “system of diagnosis and treatment directed to the viscera to improve physiologic function; typically the viscera are moved toward their fascial attachments to a point of fascial balance” n Indications n n Multiple, depending on specific organ dysfunctions Cardiac, pulmonary, GI, GU, gyn, etc. n Absolute contraindications: none
Lymphatic Techniques n Technique classification n Techniques removing restrictions to lymphatic flow vs. those promoting lymphatic flow n Indications n Lymphatic congestion (postsurgical edema), mild to moderate CHF, URI/LRI, other infections, asthma, COPD, pain due to lymphatic congestion & swelling n Absolute contraindications n Fracture, dislocation, or osteoporosis; acute hepatitis; malignancy; organ friability (inf. Mono); acute indurated lymph node
Interactive Clinical Scenarios (small groups) n Headaches n Otitis media n Post-op ileus n Constipation n Pneumonia n Back pain in pregnancy n GERD n Edema in pregnancy n Asthma n Dysmenorrhea n Sinusitis n Carpal Tunnel n Hiccups Syndrome n Others…
Summary n Osteopathic Medicine and Osteopathic Philosophy n Review of common OMT techniques n Examples of using OMT in specific clinical situations n Guidelines for allopathic preceptors
Resources n Nicholas, A and Nicholas, E. Atlas of Osteopathic Techniques. Philadelphia: Lippincott Williams & Wilkins, 2008. n Ward, R (ed). Foundations for Osteopathic Medicine. Philadelphia: Lippincott Williams & Wilkins, 2003. n Greenman, P. Principles of Manual Medicine. Philadelphia: Lippincott Williams & Wilkins, 2003. n Nelson, K and Glonek, T (ed). Somatic Dysfunction in Osteopathic Family Medicine. Philadelphia: Lippincott Williams & Wilkins, 2006.
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