Introduction to Osteopathic Medicine Ronald Januchowski, D.O. Associate Dean, VCOM

Objectives Review the history of Osteopathic Medicine Introduce / review some common techniques Practical applications

History of Osteopathic Medicine Some dates 1874 – basic principles first articulated by A.T. Still, M.D – first college founded in Kirksville, Missouri 1950 – start of full practice rights 1967 – draft extends to D.O – full practice rights in all 50 states

History of Osteopathic Medicine Basic tenets of Osteopathic Medicine The body is a unit, and the person represents a combination of body, mind, and spirit.personbodymindspirit The body is capable of self-regulation, self-healing, and health maintenance.self-regulation Structure and function are reciprocally interrelated. Rational treatment is based on an understanding of these principles: body unity, self-regulation, and the interrelationship of structure and function

History of Osteopathic Medicine Evolution of mission and identity YearIdentity or mission Manual Medicine Family Practice / manual therapy 1973 – presentFull service, multispecialty care

History of Osteopathic Medicine – Growth FIRST YEAR ENROLLEMENT IN D.O. SCHOOLS

History of Osteopathic Medicine – Growth Medical schools in the U.S. 34 D.O. schools 137 M.D. schools

History of Osteopathic Medicine – % by state Location of osteopathic medicine schools are shown in red % of physicians in state <3% 3-5% 5-10% 10-15% 15-25%

History of Osteopathic Medicine D.O. vs. M.D.’s D.O. 4 years of medical school Residency training Licensing exam Unlimited medical practice Use of Osteopathic Manipulative Treatments in addition to medicines and/or surgery M.D. 4 years of medical school Residency training Licensing exam Unlimited medical practice Use of medicines and/or surgery

History of Osteopathic Medicine D.O. vs. Chiropractors D.O. 4 years of medical school Manipulation as one method of many treatment methods Fully licensed, unlimited practice physicians Chiropractic Medicine 4 years of chiropractic school Use of spinal adjustment is main method of treatment Limited practice licensure

Terminology - Diagnosis Somatic dysfunction Impaired function of the body framework Treatable using OMT Described using Position of the part Direction which motion is best or limited TART

Terminology - Treatment Soft tissue techniques Effluerage / lymphatic techniques Counterstrain Muscle Energy HVLA

Terminology – Treatment Soft tissue stretching Lengthening linear/band muscles Gentle technique Can be performed on acute injuries

Terminology - Treatment Effleurage Gentle technique Improves lymphatic flow Reduces sympathetic tone to the area Lymphatic pump Generally gentle Improves lymphatic flow

Terminology – Treatment Counterstrain Gentle technique Find a dysfunction and place the area in a position of comfort Hold for 90 seconds and return to neutral position

Terminology - Treatment Muscle Energy Take dysfunction to barrier Resist movement away from barrier Repeat Works for small or large areas Gentle technique

Terminology - Treatment High Velocity Low Amplitude (HVLA) Takes an area of dysfunction to a barrier Thrusting through the functional barrier to improve movement

Headaches in History

Headache Types Primary Migraine (with and without aura) headache Tension-type headache Cluster headache Secondary Sinus related Vascular (AVM, aneurysm) Post trauma Structural or metabolic derangements

Exam findings Structural exam findings C1-C3 somatic dysfunction Tender points in particular headaches Frontal & orbital (C1, occipitomastoid) Periorbital (C2, occipitomastoid, infraorbital and nasal) Occipital (C4) Motion restrictions in OA area Scapular / upper thoracic dysfunction Sacral dysfunction sometime involved

Acute Treatment Plan Treat rapidly Restore patient’s function Optimize self-care Minimize side effects

Acute Treatment – TTH Aspirin Acetominophen NSAIDs Ibuprofen, Ketoprofen, Naproxen Ketorolac Combinations with caffeine Excedrin Migraine, Advil Migraine

Acute Treatment – TTH Butalbital or codeine combos Not recommended for general patients because of side effects and/or overuse May be used in patients who cannot use to other meds (pregnancy, renal failure) Triptans, Muscle relaxants Not effective in pure TTH Other methods OMT Ice, biofeedback

Preventive Treatment – TTH Amitriptyline SNRIs Mirtazipine Venlafaxine SSRIs – no benefit over placebo Anticonvulsants – limited data Gabapentin Topiramate

Preventive Treatment – TTH Tizantidine – limited studies Botulinum toxin – no effect over placebo Behavioral therapy – limited studies Physical modalities Spinal manipulation / OMT was less effective than Amitriptyline for initial pain, but had better lasting effect and less side effects Craniocervical exercises effective

Osteopathic techniques for headache treatment Soft tissue techniques OA / Cervical Spine / rhomboids Counterstrain OA / Cervical Muscle Energy Scalenes HVLA Lumbar roll

Questions?