Introduction to Osteopathic Medicine Ronald Januchowski, D.O. Associate Dean, VCOM
Jan 03, 2016
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?