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Creator of Osteopathic Medicine Andrew Taylor Still, MD, DO
Osteopathic medicine The body is a unit, an integrated unit of mind, body and spirit.
First school of Osteopathic medicine located Kirksville, Missouri in 1892
Osteopathic Manipulative Medicine (OMT) hands-on care. It involves using the hands to diagnose, treat, and prevent illness or injury. Using OMT, a DO will move your muscles and joints using techniques including stretching, gentle pressure and resistance.
Goals of OMM 1. Relieve/reduce pain 2. Improve function and range of motion 3. Increase blood and lymph flow 4. Restore normal neuronal functioning
How to make a diagnosis (important!) T-A-R-T tissue texture, asymmetry, restriction, tenderness
Various OMM Techniques -Myofascial release -Counterstrain -Muscle energy -HVLA (high velocity, low amplitude = cracking)
Palpation (Glossary of Osteo Term Definition) The application of variable manual pressure to the surface of the body to determine shape, size, consistency, position, inherent motility, and health of tissues beneath.
Palpation (other definition) Palpation consists of lightly placing the hands of fingers on the patient's body in order to discover changes in the normal condition of soft tissues, bones, or organs beneath the surface of the skin, as well as the skin itself.
Dominant Hand & Eye Always stand with dominant eye closest to patient
DO's best tools Your Hands!!
Sensation The pads of thumb and the first two fingers (most sensitive part of hand)
Determining temperature dorsal part (knuckle side) of the 3rd, 4th, and 5th fingers.
What to look for? 1. Understand what feels normal before you look for abnormal things. 2. Understand that we are feeling different layers of skin, tissue, muscle, etc.
Steps toward diagnosis 1. TART 2. Observation 3. Passive motion: Doc moves patient 4. Active motion: Patient moves, doc doesn't help
Active Motion Range Where you can naturally move on your own (for ex: neck, how far you can turn to each side without strain)
Physiologic Barrier The limit to which a person can actively move (for ex: the point at which the neck cannot naturally turn anymore)
Anatomic Barrier -barrier provided by normal anatomy; going beyond an anatomic barrier will cause injury. -the limit to which a patient can be passively moved.
Restrictive Barrier Caused by somatic dysfunction diminishing the normal range of motion and creating a new center for the range of motion.
Medial to the middle
Lateral to the side
Anterior/Ventral to the front
Posterior/Dorsal to the back
Proximal closer to point of attachment or observation
Distal farther away from point of attachment or observation
Superficial close to the surface
Deep ...deep.
Cephalad head (towards head)
Caudad tail (towards feet)
Ipsilateral same side
Contralateral opposite side
the three body positions 1. Prone 2. Supine. 3. Lateral Recumbent
Prone On the belly (army crawl)
Supine on the back (belly up)
Lateral Recumbent leaning (contraposto)
Anatomical Landmarks -Acromion -C7 (Vertebra prominens) -T3 (spine of scapula) -T7 (inferior border of scapula) -L4 (iliac Crest) -PSIS -ASIS -Medial Melleoli (inner ankle bone)
Acromion a continuation of the scapular spine; articulates with the clavicle
Vertebra prominens Seventh cervical vertebra (C7) - prominent spinous juts out.
Scapular Spine in line with third thoracic vertebra (T3)
Iliac Crest Top of the pelvis (in line with the fourth lumbar vertebra (L4)
PSIS Posterior superior iliac spine (back of pelvic bone)
ASIS Anterior superior iliac spine (front of pelvic bone)
Parts of Spine (top to bottom) -Cervical (7 vert) -Thoracic (12 vert) -Lumbar (5 vert) -Sacrum (5 fused vert) -Coccyx (4 fused vert)
Lordosis a medical term used to describe an inward curvature of a portion of the lumbar and cervical vertebral column.
Kyphosis a medical term used to describe an outward curvature of a portion of the thoracic and sacrum vertebral column.
Static Symmetry Exam 1. Examine patient from head to toe 2. Make sure you are standing far enough away and keeping eyes level to plane you are examining 3. examine from both front and back 4. note normal (or abnormal) curvature of each part of the spine.
Static Symmetry Exam - Observe and Note... 1. Any head tilt/rotation 2. Shoulder heigh (even?) 3. Arm length/rotation 4. Torso rotation 5. Level of knee and any other things in the legs
Somatic Dysfunctions Impaired or altered function of related components of the somatic (body framework) system -- skeletal, arthrodial and myofascial structures, and their related vascular, lymphatic, and neural elements.
Somatic dysfunctions are named… in the direction of ease! (Usually in three directions) Ex
Freyette's Laws A set of laws to help determine the type of dysfunction in the vertebral column (The first two laws apply only to lumbar and thoracic spine, the 3rd law applies to whole vertebral column)
Freyette's law one When a spinal vertebrae is in neutral, the rotational component and side bending component will be to opposite sides. (Applies to a group dysfunction and there is no flexion or extension component)
Freyette's law two When a spinal vertebrae is non-neutral (flexed or extended), side bending and rotation are to the same side (Applies when the somatic dysfunction is in a single vertebrae and is made much worse on flexion or extension)
Freyette's law 3 Motion is reduced in two planes when there is introduction of motion in the third plane (When there is somatic dysfunction in one plane of motion it will impact the other two remaining planes of motion as well)
Types of treatments 1. soft tissue 2. myofascial release 3. counterstrain 4. muscle energy 5. HVLA 6. facilitated positional release (treatments are classified as either direct or indirect)
Direct engages the most restrictive barrier, the patient is set up opposite the diagnosis (remember somatic dysfunctions are named for their EASE)
Indirect move patient towards ease!, the patient is set up in the same direction as the diagnosis
Direct Techniques Soft tissue, myofascial release, muscle energy, HVLA
Indirect techniques Myofascial release, counterstrain, muscle energy, facilitated positional release
Soft Tissue pressure, traction, and/or separation of muscle origin and insertion while monitoring tissue response and motion changes alternating pressure forces, Used to reduce tension (muscle hypertonicity) before using HVLA or muscle energy, No risks
Myofascial Release engages continual placatory feedback to achieve release of myofascial tissues. either a direct or indirect technique. (treat headaches with myofacial release of thoracic!) No absolute contraindications. very minimal pressure
Counterstrain Treatment of tender points that can be related to segmental areas where dysfunction present ( patient placed in position of greatest comfort and held there for 90 secs or until tissue is released). Absol contraindications are based on patient position
Created by: Kanarema