Osteopathic Medicine: The Story

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Osteopathic Medicine: The Story

Raymond J. Hruby, DO, MS, FAAO


• At the end of all parts of this workshop theparticipant will be able to:• Describe the basic elements of the history,development, philosophy and principles ofosteopathic medicine• Describe the elements of an osteopathic structuralexamination• Palpate musculoskeletal tissues and describe thedifferences between normal tissue and tissue alteredby the presence of somatic dysfunction• Integrate osteopathic principles into the teaching ofhis/her respective discipline where appropriate


So easy even I can do it!


A.T. Still, MD, DO 1828 - 1917


• Disillusionment with medical practice of histime, especially pharmaceuticals• Recollection of his father’s sermons• Spinal meningitis epidemic and loss ofseveral of his family members• Recollection of his self-treatment of hisheadaches as a youth


Colleges of Osteopathic Medicinein the United StatesWAMEORWIMINYCACOKSIAMOILKYOHPAWV VNJAZOKMSTNGATXFL


• Body Unity (Holism)• Self-Healing and Self-Regulation of theBody• Interrelationship of Structure and Function• Rational Treatment


• Body Unity (Holism)• The patient with thedisease, NOT thedisease that has apatient attached to it.


• Self-regulation• Self-healing• Can (and should)be optimizedbefore includingother interventions


• Interrelationship ofstructure andfunction• Importance of themusculoskeletalsystem in healthand disease


• Rational Treatment• Based on theapplication of theprevious threeprinciplesE = mc 2


Primary and SecondaryMachinery functions arecoordinated by thenervous system


Coordination via thenervous system,especially theautonomic systemOrdinary view ofthe ANS


• Types of autonomic reflexes• Viscerosomatic• Somatovisceral• Permutations of the above, e.g.,viscerosomatovisceral


• Definition• Localized visceral stimuli producing patterns ofreflex response in segmentally related somaticstructures• Foundations for Osteopathic Medicine, p. 1136


• Similar to referred pain,but• Includes the palpable signsof somatic dysfunction


• Definition• Localized somatic stimuli producing patterns ofreflex response in segmentally related visceralstructures• Foundations for Osteopathic Medicine, p. 1136


• A Reflector of pathophysiologicalprocesses• An Affector of pathophysiologicalprocesses• An Entry point of evaluation andtreatment42


1. Improve posture and body movement2. Improve the movement of fluids to andfrom tissues3. Reduce or alleviate facilitated segments4. Enhance homeostatic mechanisms5. Maximize immune and endocrine functionsto decrease reliance on medications,facilitate reliance on good nutrition andexercise, and alleviate pain, anxiety anddiscomfort


• Biomechanical• Neurological• Respiratory-Circulatory• Metabolic• Behavioral45


FASCIALIGAMENTSMUSCLESJOINTSPOSTURE AND MOTION46


BeforeMitchellAfter• 1/4” heel lift underright heel corrects forshort leg• levels sacral base• straightens spine• relieves pain47


Referred Pain(Viscerosomatic reflexes)CNS-PNS-ANS integrationAutonomic balanceJone’s tenderpointsTravell’s trigger points48


WAK 49


Arterial supplyVenous and lymphatic drainageCSF flowDiaphragm motion50


• Decrease somatic (proprioceptor,mechanoreceptor, nociceptor) afferent inputinto spinal cord to decrease potential overactivationof sympathetic efferents at relatedneural segments - local SNS hyperactivity canconstrict blood vessels to visceral structures• Heads of ribs are just posterior to thesympathetic chain ganglia - a potentialmechanical influence on SNS activity level53


• Transition areas of the spine - myofascial tension canpotentially restrict fluid movement• Occipito-atlantal junction: jugular foramen• Cervico-thoracic junction: thoracic inlet• Thoraco-lumbar junction: diaphragm• Lumbo-sacral junction: pelvic diaphragm• Also influenced by sympathetic tone due to SNSinnervation of veins and lymphatic vessels54


Post-cholecystectomy -1989-90• Open circles = FVC after OMT• Closed circles = FVC after incentive spirometry55


• Endocrine functions• Immune functions• Nutrition• Medications• Energy exchange - body economy• (Essentially applied biochemistry)56


Ed Stiles, D.O.N=50DysrhythmiaShockWithout OMTWith OMTMortality0% 50% 100%WAK57


• PILOT STUDY: 30 PATIENTS• HOSPITALIZED PATIENTS• RANDOM ASSIGNMENT• GENERAL JOINT MOBILIZATION• HIPS, SHOULDERS• SACRUM, SPINE, RIBS• DECREASED LENGTH OF STAY• DECREASED ANALGESIC USE• INCREASED PATIENT SATISFACTION58


DiagnosisNon-OMT1. COPD 5 DaysOMT %4.3 Days 12 %2. Pediatric 5.4 DaysLower respiratorytract infection4.9 Days 9 %3. Hysterectomy 9.1 Days8.0 Days 14 %59


• Allergies• Immune response to hepatitis b vaccination• Asthma• Affective disorders• General adaptive response (stress)• Dysmenorrhea• Obstetrics


• Biological• age• co-morbidity• Psychological• emotions• psychiatric illness• Social• interpersonal relations• substance abuse - chemical dependency61


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RESTORATIONOF EXTERNALAND INTERNALRESOURCESWELLNESSSTRESSORSDECREASED CAPACITYFOR WELLNESSINADEQUATEEXTERNAL ANDINTERNALRESOURCESCONTINUEDEFFECT OFSTRESSORSILLNESSTREATMENT OFROOT CAUSES


WELLNESS

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