Introduction to Osteopathic Medicine for Non-DO Faculty: What Makes an Osteopathic Education Different? Educational Council of Osteopathic Principles Photo courtesy of NSU-COM

Copyright © 2010, AACOM. All rights reserved. 19 th Century America Age of Heroic Medicine  Rise of Allopathy  Phlebotomy  Medicinals  Surgery  Founding of American Medical Association  1847

Copyright © 2010, AACOM. All rights reserved. Becoming a Physician in 19 th Century America  Attend medical school  1760 William Shippen, Jr. lectures on anatomy in Philadelphia  1765 Morgan funds first U.S. medical school in Philadelphia  1790 medical journal published in New York  Set up practice  Generally richer patients  More urban practice  Apprentice with a registered/ licensed physician  One – several years  Learn medicinals, midwifery, surgery  Mentor would sign statement  Sometimes involved test, sometimes just mentor’s statement  Set up practice  Common people as patients  More rural practice

Copyright © 2010, AACOM. All rights reserved. 19 th Century America Reactions to Age of Heroic Medicine Alternatives to Contemporary Medicine:  Thompsonism  Grahmism  HydroTherapy  Lightning Bone Setters  Chiropractic  Homeopathic

Copyright © 2010, AACOM. All rights reserved. A.T. Still, MD  Rural farmer, hunter, inventor, local politician  Civil War abolitionist  Personal tragedy 1864  Denounces medical treatment  Becomes a medical reformer

Copyright © 2010, AACOM. All rights reserved. June 22, 1874 Flies high the banner of osteopathy. Relocates to Kirksville, Missouri. PATHY OSTEO

Copyright © 2010, AACOM. All rights reserved. May 10, 1892  Obtains charter for the first school.  American School of Osteopathy (ASO) “To improve our systems of surgery, midwifery, and the treatment of diseases in which the adjustment of bones is the leading feature of this school of Pathology. Also to instruct and qualify students so that they may lawfully practice the Science of Osteopathy as taught and practiced by A.T. Still, the discoverer of this philosophy.”

Copyright © 2010, AACOM. All rights reserved. Tenets of Osteopathy 1.The human body is a functional unit. Mind, body, and spirit are interconnected. 2.Form and function are inter-dependant. 3.The human body has the innate ability to heal itself. 4.Osteopathic Manipulative Treatment is based upon individualized, rational application of the above tenets.

Copyright © 2010, AACOM. All rights reserved. Anatomy/Development Module

Copyright © 2010, AACOM. All rights reserved. “It is impossible for an osteopathic physician to perform a physical examination without knowledge of anatomy.”

Copyright © 2010, AACOM. All rights reserved.  The body’s numerous and complex anatomic structures  The interrelationship between anatomy and physiology  The critical importance of the neuro- musculoskeletal system in human function  That the knowledge of anatomy is essential to the practice of medicine and surgery The practicing osteopathic physician needs to understand:

Copyright © 2010, AACOM. All rights reserved.  Surface Anatomy  Visualization  Palpation  Functional Anatomy  Anatomic elements related to the body’s biomechanical functions  Surgical Anatomy  Knowledge required for surgical diagnosis and treatment  Cross-sectional anatomy “All osteopathic physicians use their knowledge of anatomy in practice”

Copyright © 2010, AACOM. All rights reserved. Knee Pain Case A patient presents with knee pain.

Copyright © 2010, AACOM. All rights reserved. Differential Diagnosis Basic Categories  Infection  Inflammation  Tumor  Trauma  Genetic  Somatic dysfunction  Psychological

Copyright © 2010, AACOM. All rights reserved. Differential Diagnosis of Knee Pain Includes:  Patellofemoral syndrome  Iliotibial band syndrome  Patellar tendonitis  Anserine bursitis  Meniscus tear  Collateral ligament tear – medial or lateral  Cruciate ligament tear – anterior or posterior  Osgood Schlatter  Osteochondritis dessicans  Neuropathic arthropathy  Charcot Joint  Tumor (osteosarcoma)  Referred pain (hip = avascular necrosis)  Prepatellar bursitis  Baker’s cyst (popliteal)  Septic Joint  Gonococcal  Arthritis  Osteo  Rheumatoid  Gout  Septic  Pseudogout  Reactive arthritis (Reiters)  Medial Plica syndrome  Referred pain from back  Sciatica  Fracture

Copyright © 2010, AACOM. All rights reserved. Applied Anatomy and Knee Pain  Surface and functional anatomy are required for examination and treatment of the painful knee.  Surgical anatomy may be required for the treatment of the painful knee.

Copyright © 2010, AACOM. All rights reserved. Osteopathic Considerations  Discussion of likely anatomic involvement in the knee pain case.  Probably will focus on functional vs. surgical possibilities.

Copyright © 2010, AACOM. All rights reserved. Medicine and A.T. Still  “Man should study and use the drugs compounded in his own body.”  Autobiography of A.T. Still, p. 89  The basis of scientific medicine

Copyright © 2010, AACOM. All rights reserved. Not all of osteopathic principles and practice is osteopathic manipulative medicine. Osteopathic medical students study all of medicine, surgery and obstetrics. In addition, they study osteopathic philosophy, principles and practice for about 200 hours.

Copyright © 2010, AACOM. All rights reserved. OMM Perspective for Analyzing Patient Problems 1.Biomechanics Is there a biomechanical component to the patient’s condition? 2.Fluid flow Are there issues with fluid flow that could be solved by releasing tissue tension and enhancing movement and respiration? 3.Nervous system, including autonomics Is the sympathetic nervous system up regulated to a level that impedes organic or systemic function? Are there peripheral nerve issues that can be improved by releasing tissue tension and compression?

Copyright © 2010, AACOM. All rights reserved. Osteopathic Manipulative Treatment (OMT) OMT is used to:  Lengthen hypertonic muscles and connective tissue.  Help joint surfaces glide more normally in physiologic motion.  Decrease pressure on sensitive small vessels and lymphatics.  Decrease nociceptive input to the CNS, which may decrease level of sympathetic nervous system activation.

Copyright © 2010, AACOM. All rights reserved. Current Numbers  26 osteopathic colleges at 32 sites in 23 states.  About 60,000 DOs in practice.  Projection: by 2020, ¼ of all medical students will be osteopathic medical students. Doctor of Osteopathic Medicine