Photos used with permission Demystifying OMT Helen Luce, DO Assistant Professor University of Wisconsin School of Medicine and Public Health - Department of Family Medicine

Photos used with permission OBJECTIVES Define osteopathic medicine Define osteopathic medicine Describe the osteopathic philosophy Describe the osteopathic philosophy Describe three ways in which OMM can provide added benefit for the patient when used in conjunction with other treatment modalities Describe three ways in which OMM can provide added benefit for the patient when used in conjunction with other treatment modalities List one physiological explanation describing the mechanism which allows OMM to be effective List one physiological explanation describing the mechanism which allows OMM to be effective List three non-musculoskeletal conditions where OMM can provide value added treatment for a patient List three non-musculoskeletal conditions where OMM can provide value added treatment for a patient

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DEFINITION Osteopathic Medicine Osteopathic Medicine – 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

Photos used with permission Doctor of Osteopathic Medicine Fully-licensed physician with additional training in osteopathic palpatory diagnosis and manipulative therapy Fully-licensed physician with additional training in osteopathic palpatory diagnosis and manipulative therapy May specialize in any area of medicine and surgery May specialize in any area of medicine and surgery Uses manipulative techniques, as well as traditional diagnostic and therapeutic procedures, to diagnose and treat dysfunction in the body Uses manipulative techniques, as well as traditional diagnostic and therapeutic procedures, to diagnose and treat dysfunction in the body

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HISTORY Andrew Taylor Still MD founded Osteopathic Medicine in 1874 Andrew Taylor Still MD founded Osteopathic Medicine in 1874 Left traditional medical practice of the time, including leeching and bleeding Left traditional medical practice of the time, including leeching and bleeding Believed best way to fight disease was by naturally stimulating the body’s immune system Believed best way to fight disease was by naturally stimulating the body’s immune system

Photos used with permission HISTORY A.T. Still founded first school of osteopathic medicine in 1892 in Kirksville, MO A.T. Still founded first school of osteopathic medicine in 1892 in Kirksville, MO Pioneered the concept of wellness Pioneered the concept of wellness Identified the musculoskeletal system as key element of health Identified the musculoskeletal system as key element of health

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OSTEOPATHIC PHILOSOPHY Four basic principles Four basic principles – 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

Photos used with permission OSTEOPATHIC PRINCIPLES

Photos used with permission HOST + DISEASE = ILLNESS HOST COMPONENT DISEASE COMPONENT Host refers to musculoskeletal system Disease refers to medical diagnosis

Photos used with permission HOST + DISEASE = ILLNESS - 2 HOST COMPONENT DISEASE COMPONENT Host refers to musculoskeletal system such as muscle pain, somatic reflex, etc. Disease refers to medical diagnosis such as asthma, kidney stone, etc.

Photos used with permission HOST + DISEASE = ILLNESS - 3 HOST COMPONENT DISEASE COMPONENT Host refers to musculoskeletal system such as muscle pain, somatic reflex, etc. Disease refers to medical diagnosis such as asthma, kidney stone, low back pain, etc.

Photos used with permission HOST + DISEASE = ILLNESS - 4 HOST COMPONENT DISEASE COMPONENT Host refers to musculoskeletal system such as muscle pain, somatic reflex, etc. Disease refers to medical diagnosis such as asthma, kidney stone, low back pain, etc. Treated with OMM Treated with many modalities, including surgery, medication, psychotherapy, rest, etc.

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VALUE ADDED BY DO’s Emphasis on primary care Emphasis on primary care Practice “wholistic” approach Practice “wholistic” approach Focus on preventative health Focus on preventative health OMT incorporated into practice OMT incorporated into practice

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OSTEOPATHIC MANIPULATIVE TREATMENT (OMT) Includes many different techniques Includes many different techniques Requires additional training ( hrs during med school) Requires additional training ( hrs during med school) Requires ongoing practice and continuing education Requires ongoing practice and continuing education

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SOMATIC DYSFUNCTION Impaired or altered function of related components of somatic system (body framework) Impaired or altered function of related components of somatic system (body framework) – Skeletal structures – Myofascial structures – Related vascular, lymphatic, & neural elements

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HANDS-ON CARE Somatic Dysfunction Palpation (diagnosis) Somatic Dysfunction Palpation (diagnosis) T : Tissue texture abnormalities T : Tissue texture abnormalities A : Asymmetry A : Asymmetry R : Restriction of motion R : Restriction of motion T : Tenderness T : Tenderness

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COMMON OMT TECHNIQUES HVLA HVLA Muscle Energy Muscle Energy Soft Tissue Soft Tissue Strain/Counterstrain Strain/Counterstrain Functional Functional Articulatory Articulatory Myofascial Release Myofascial Release Springing Springing Cranial Cranial

Photos used with permission FORCES APPLIED IN OMT Extrinsic Extrinsic –Supplied by physician Thrusting Thrusting Springing Springing Traction Traction Gravity Gravity Mechanical table Mechanical table Intrinsic Intrinsic –Supplied by patient Homeostatic Respiration Muscle contraction

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BARRIERS TO MOTION Anatomic Barrier Anatomic Barrier Physiologic Barrier Physiologic Barrier Restrictive Barrier Restrictive Barrier Anatomic Physiologic Restrictive Physiologic Anatomic Anatomic Physiologic Restrictive Physiologic Anatomic Barrier Barrier Barrier Barrier Barrier Barrier Barrier Barrier Barrier Barrier

Photos used with permission PHYSIOLOGICAL THEORY HVLA “pop” HVLA “pop” – Sudden distraction of joint surfaces produces a nitrogen bubble, along with noise, and increased freedom of motion. – “Pop” not necessary for a successful treatment. Muscle energy Muscle energy – Increase blood and other fluid movement to remove waste products and increase tissue oxygenation. – To tone inactive muscles that might be weak.

Photos used with permission SAFETY OF OMT Low rate of complications (1 in 1 million) Low rate of complications (1 in 1 million) Careful patient and modality selection Careful patient and modality selection Most common complications Most common complications – Vertebrovascular accidents – Cauda Equina syndrome Modality most associated with complications is HVLA Modality most associated with complications is HVLA

Photos used with permission CONTRAINDICATIONS Rheumatoid Arthritis Rheumatoid Arthritis Fracture Fracture Osteoporosis Osteoporosis Primary bone tumor Primary bone tumor Bone metastases Bone metastases Cervical stenosis Cervical stenosis Vascular insufficiency Vascular insufficiency CVA CVA Bleeding disorder/ anticoagulated Bleeding disorder/ anticoagulated Osteomyelitis Osteomyelitis Down’s syndrome Down’s syndrome Ehler-Danlos syndrome with atlanto-axial ligament involvement Ehler-Danlos syndrome with atlanto-axial ligament involvement Ocular lens implant (early post-op period) Ocular lens implant (early post-op period)

Photos used with permission OTHER CONDITIONS OMM can provide added value to treatment of non-musculoskeletal conditions OMM can provide added value to treatment of non-musculoskeletal conditions –Asthma, pneumonia, sinusitis, ear infections, colic, post-operative recovery, MI, constipation, diarrhea, dysmenorrhea, labor pain, edema, etc.

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