Osteopathic manipulative medicine


Osteopathic manipulative medicine
Osteopathic manipulative medicine
Intervention
ICD-10-PCS 7
ICD-9-CM 93.6
MeSH D026301

Osteopathic Manipulative Medicine (OMM) is the application of the distinct osteopathic philosophy, structural diagnosis and use of Osteopathic Manipulative Technique (OMT) in the diagnosis and management of the patient.[1] OMM takes into account the physical and mental health of a patient, and how either aspect could be contributing to the disease state. A Doctor of Osteopathic Medicine (D.O.) is trained to perform a structural diagnosis integrated into the entire history and physical taking process, and to use OMT techniques when appropriate.

Contents

Origins

Andrew Taylor Still, M.D., D.O. was a 19th century American doctor who developed and promoted osteopathic medicine. A physician and Civil War surgeon, Still became disenchanted with contemporary medical practice after he lost three of his children to spinal meningitis. This loss motivated him to attempt to improve medicine.

Still used his understanding of anatomy to first screen for structural abnormalities (somatic dysfunction) and then restore normal functionality as an essential part of treatment. He also emphasized the connection between mental, physical, emotional and spiritual health and taught that each plays an important role in overall patient health. As a result of his studies, a distinct approach to healthcare was created.

A. T. Still defined osteopathy as "that science which consists of such exact, exhaustive, and verifiable knowledge of the structure and function of the human mechanism, anatomical, physiological and psychological, including the chemistry and physics of its known elements, as has made discoverable certain organic laws and remedial resources, within the body itself, by which nature under the scientific treatment peculiar to osteopathic practice, apart from all ordinary methods of extraneous, artificial, or medicinal stimulation, and in harmonious accord with its own mechanical principles, molecular activities, and metabolic processes, may recover from displacements, disorganizations, derangements, and consequent disease, and regained its normal equilibrium of form and function in health and strength." [2]

Principles

The osteopathic medical philosophy is defined as the concept of health care that embraces the concept of the unity of the living organism’s structure (anatomy) and function (physiology). These are the four major principles of osteopathy:[3]

  1. The body is an integrated unit of mind, body, and spirit
  2. The body possesses self-regulatory mechanisms, having the inherent capacity to defend, repair, and remodel itself.
  3. Structure and function are reciprocally inter-related.
  4. Rational therapy is based on consideration of the first three principles.

These principles are not held by osteopathic physicians to be empirical laws; they serve, rather, as the underpinnings of the osteopathic philosophy on health and disease.

Diagnosing disease

There are five main components to osteopathic care. Since each plays an important role in the overall health of a patient, each should be considered when diagnosing and treating a patient. The five components are:

  • Biomechanical
  • Neurological
  • Respiratory/Circulatory
  • Metabolic
  • Behavioral

Treatment

OMT is only one part of Osteopathic Medicine. It may be used alone or in combinations with pharmacotherapy, rehabilitation, surgery, patient education, diet and exercise all play important roles in treating osteopathically. OMT techniques are not necessarily unique to osteopathic medicine. Other disciplines, such as physical therapy or chiropractics, use similar techniques.

OMT is commonly used to treat musculoskeletal problems like lower back pain [4] [5] and thoracic outlet syndrome[6] , but it may also be used as an adjunct therapy for other disorders like migraine[7] and pneumonia[8] .

Muscle Energy

Muscle energy techniques address somatic dysfunction through stretching and muscle contraction. For example, if a person is unable to fully abduct their arm, the treating physician raises the person's arm to the edge of the restrictive barrier. The patient then tries to lower their arm, while the physician provides resistance. Once the patient relaxes, their range of motion increases slightly. The alternating contraction and relaxation helps the treated muscle increase its range of motion.

Counterstrain

Counterstrain is a system of diagnosis and treatment that considers the dysfunction to be a continuing, inappropriate strain reflex, which is inhibited by applying a position of mild strain in the direction exactly opposite to that of the reflex; this is accomplished by specific directed positioning about the point of tenderness to achieve the desired therapeutic response.

Myofascial release

Myofascial release is a form of soft tissue therapy used to treat somatic dysfunction and resulting pain and restriction of motion. It uses continual palpatory feedback to achieve release of myofascial tissues.[9] This is accomplished by relaxing contracted muscles, increasing circulation and lymphatic drainage, and stimulating the stretch reflex of muscles and overlying fascia.[10]

Fascia is the soft tissue component of the connective tissue that provides support and protection for most structures within the human body, including muscle. This soft tissue can become restricted due to psychogenic disease, overuse, trauma, infectious agents, or inactivity, often resulting in pain, muscle tension, and corresponding diminished blood flow. Although fascia and its corresponding muscle are the main targets of myofascial release, other tissue may be affected as well, including other connective tissue.[10]

References

  1. ^ Glossary of Osteopathic Terminology, Educational Council on Osteopathic Principles (ECOP), American Association of Colleges of Osteopathic Medicine (AACOM), Revised April 2009, p.28.
  2. ^ [Autobiography of A.T. Still, A.T. Still, Kirksville, Missouri, 1908, p. 403.]
  3. ^ [1]Glossary of Osteopathic Terminology, Educational Council on Osteopathic Principles (ECOP), American Association of Colleges of Osteopathic Medicine (AACOM), Revised April 2009, p.33.
  4. ^ Cruser, dA; Maurer D, Hensel K, Brown SK, White K, Stoll ST (August 1, 2011). "A randomized, controlled trial of osteopathic manipulative treatment for acute low back pain in active duty military personnel". J Man Manipulative Ther. 111 (10): 574–575. doi:10.1179/2042618611Y.0000000016. http://www.jaoa.org/content/111/10/574.full?etoc. Retrieved 8 November 2011. 
  5. ^ Licciardone, JC; Buchanan, S, Hensel, KL, King, HH, Fulda, KG, Stoll, ST (2010 Jan). "Osteopathic manipulative treatment of back pain and related symptoms during pregnancy: a randomized controlled trial.". American journal of obstetrics and gynecology 202 (1): 43.e1-8. PMID 19766977. 
  6. ^ Sucher, BM (2011 Sep). "Ultrasonography-guided osteopathic manipulative treatment for a patient with thoracic outlet syndrome.". The Journal of the American Osteopathic Association 111 (9): 543–7. PMID 21955534. 
  7. ^ Schabert, E; Crow, WT (2009 Aug). "Impact of osteopathic manipulative treatment on cost of care for patients with migraine headache: a retrospective review of patient records.". The Journal of the American Osteopathic Association 109 (8): 403–7. PMID 19706829. 
  8. ^ Noll, DR; Degenhardt, BF, Morley, TF, Blais, FX, Hortos, KA, Hensel, K, Johnson, JC, Pasta, DJ, Stoll, ST (2010 Mar 19). "Efficacy of osteopathic manipulation as an adjunctive treatment for hospitalized patients with pneumonia: a randomized controlled trial.". Osteopathic medicine and primary care 4: 2. PMID 20302619. 
  9. ^ Glossary of Osteopathic Terminology, Educational Council on Osteopathic Principles (ECOP), American Association of Colleges of Osteopathic Medicine (AACOM), Revised April 2009, page 31.
  10. ^ a b DiGiovanna, Eileen; Stanley Schiowitz, Dennis J. Dowling (2005) [1991]. "Myofascial (Soft Tissue) Techniques (Chapter 12)". An Osteopathic Approach to Diagnosis and Treatment (Third ed.). Philadelphia, PA: Lippincott Williams & Wilkins. pp. 80–82. 

Further reading

  • Ward, Robert C. et al.; Foundations for Osteopathic Medicine (2nd ed.). Philadelphia: Lippincot Williams and Wilkins. ISBN 0-7817-3497-5.
  • American Association of Colleges of Osteopathic Medicine (2009); Glossary of Osteopathic Terminology.

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