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.

1892 – first college founded in Kirksville, Missouri

1950 – start of full practice rights1967 – draft extends to D.O.1973 – 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.

The body is capable of self-regulation, self-healing, and health maintenance.

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

Year Identity or mission

1892-1950 Manual Medicine

1951-1972 Family Practice / manual therapy

1973 – present Full 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. schools137 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 MedicineD.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 MedicineD.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 dysfunctionImpaired function of the body

frameworkTreatable using OMTDescribed 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 stretchingLengthening linear/band musclesGentle techniqueCan be performed on acute injuries

Terminology - Treatment

Effleurage Gentle techniqueImproves lymphatic flowReduces sympathetic tone to the area

Lymphatic pumpGenerally gentleImproves lymphatic flow

Terminology – Treatment

CounterstrainGentle techniqueFind a dysfunction and place the area

in a position of comfortHold for 90 seconds and return to

neutral position

Terminology - Treatment

Muscle EnergyTake dysfunction to barrierResist movement away from barrierRepeatWorks for small or large areasGentle technique

Terminology - Treatment

High Velocity Low Amplitude (HVLA) Takes an area of dysfunction to a

barrierThrusting through the functional

barrier to improve movement

Headaches in History

Headaches in History

Headache Types Primary

Migraine (with and without aura) headache Tension-type headache Cluster headache

SecondarySinus relatedVascular (AVM, aneurysm)Post traumaStructural or metabolic derangements

Exam findings Structural exam findings

C1-C3 somatic dysfunctionTender points in particular headaches

• Frontal & orbital (C1, occipitomastoid)• Periorbital (C2, occipitomastoid, infraorbital and nasal)• Occipital (C4)

Motion restrictions in OA areaScapular / upper thoracic dysfunctionSacral 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, NaproxenKetorolac

Combinations with caffeineExcedrin 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 relaxantsNot effective in pure TTH

Other methodsOMT Ice, biofeedback

Preventive Treatment – TTH Amitriptyline SNRIs

MirtazipineVenlafaxine

SSRIs – no benefit over placebo Anticonvulsants – limited data

GabapentinTopiramate

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 techniquesOA / Cervical Spine / rhomboids

CounterstrainOA / Cervical

Muscle EnergyScalenes

HVLALumbar roll

Questions?