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OMT for LBP

OMT for LBP. Samuel A. Yoakum, DO, MS, FAAPMR Tennessee Orthopaedic Clinics: TOC Spine Knoxville, TN. Disclosures. none. Outline. Background Definitions Diagnosis Techniques. Manual therapy. Acupressure Bodywork Bowen technique Chiropractic Craniosacral therapy

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OMT for LBP

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  1. OMT for LBP Samuel A. Yoakum, DO, MS, FAAPMR Tennessee Orthopaedic Clinics: TOC Spine Knoxville, TN

  2. Disclosures none

  3. Outline Background Definitions Diagnosis Techniques

  4. Manual therapy • Acupressure • Bodywork • Bowen technique • Chiropractic • Craniosacral therapy • Indian head massage • Lomilomi • Manual lymphatic drainage • Massage therapy • Naprapathy • Osteopathic medicine • Physical therapy • Rolfing structural integration • Shiatsu • Thai massage • Tui na • Watsu

  5. Osteopathic Medicine Definitions: •Osteopathy = Osteopathic medicine •Osteopathic manipulative medicine = OMM •Osteopathic manipulative treatment/techniques = OMT •Doctor of Osteopathic Medicine = DO According to the World Osteopathic Health Organization, Osteopathy is a “…system of healthcare which relies on manual contact for diagnosis and treatment. It respects the relationship of body, mind and spirit in health and disease; it lays emphasis on the structural and functional integrity of the body and the body's intrinsic tendency for self-healing.”

  6. Osteopathic Medicine Andrew Taylor Still • • Founded Osteopathy 1870’s •Previously trained as an MD • Lost entire family to meningitis • Devoted to the study of anatomy and physiology • • Early Hipster

  7. Tenets of Osteopathy • The body is a unit • Understanding this concept allows the treatment of patients as a functional whole. • Structure and Function are interrelated • Still’s philosophy: “Disease is the result of anatomical abnormalities followed by physiologic discord” • The body possesses self-regulatory and self-healing mechanisms • Rational treatment is based on applying these principles

  8. Diagnosis Somatic Dysfunction • Tissue Texture Changes • Boggy/edematous, taught/hypertonic “knots”, ropy/fibrosed, atrophied, rigid, moist, dry • Asymmetry • Macro and Micro • Restriction of motion = a deeper look at ROM • Named for FREEDOM Of MOTION • Restricted motion is the BARRIER • tenderness • Tenderpoints vs. Triggerpoints

  9. Tissue Texture Changes • Acute • Edematous • Erythematous • Boggy • Slick, sweaty • Chronic • Flat • Cool • Leathery, low tone • Flaccid, ropy, fibrotic

  10. Asymmetry • Group curvature • Single segment disfunction • Compare Side-to-side • Mastoid • Acromion • Lower ribs • Iliac crests • Greater trochanters • Lateral femoral condyles • Lateral malleoli

  11. Restriction of motion • Alignment vs Restriction • - everyone has some asymmetries • - sometimes it points to dysfunction • - sometimes it is normal • Symmetry is less of a goal than improving restriction

  12. The Barrier Concept • BARRIER stops motion • FREEDOM Of MOTION is opposite the barrier • Barriers • Anatomical • Physiological • Restrictive

  13. Anatomical & Physiological Barriers

  14. So what is wrong? • Assessment and Diagnosis • Observe gait • Structural exam: standing, seated • Axial spine exam • Extremities • Tenderness and Tissue Texture change are homing beacons • Asymmetry sets the stage • Restriction of motion answers the question

  15. Common LBP Problems • Diagnosis • Soft tissue injury • Myofascial strain / tenderpoints • Muscular: iliopsoas, QL, paraspinals, hamstrings, piriformis, gluts, multifidi • Malrotated Sacrum and/or Ilium • Lumbar Segmental restriction

  16. Key: Know What You Are Treating • Soft tissue – skin, adipose, superficial fascia • Deep Fascia – layers, lines, planes, strain patterns • Muscle – follow the fibers • Joint – vertebral segments, articulations, syndesmoses

  17. Know how you are treating • Direct Techniques • Engage (go into) the dysfunctional barrier • Goal is moving through the barrier to restore normal motion • Indirect Techniques • Disengage (go away from) the barrier • Using the path of least resistance • Combined Techniques • Begin indirect, then go direct

  18. OMT • Soft tissue mobilization / Articulatory Techniques • Direct • Myofascial Release (MFR) • Direct or Indirect • Muscle Energy (contract-relax) • Direct • Jones Counterstrain & FPR • Indirect • High Velocity Low Amplitude (HVLA) • Direct • Craniosacral • Direct or Indirect

  19. Soft Tissue Mobilization • High Yield Targets: • Lumbar paraspinals, T-L junction, flank • Allows treatment to other parts of the body to be more effective. • Gently and directly applying pressure through the soft tissue layers: skin, fascia, adipose, muscle. • Deep articulation, in contrast, engages joint motion

  20. Myofascial Release (MFR) • High Yield Targets: • Fascial restrictions • TL junction, iliolumbar ligament, sacral • MFR is an umbrella term encompassing several types of osteopathic manipulative techniques (OMT) that stretch and release muscle and fascia restrictions. • MFR first involves palpating a restriction in the fascia/soft tissue. • Direct MFR = practitioner engages the restrictive barrier and holds until a release is felt in the tissue. • Indirect MFR = practitioner moves the myofascial structures away from the restrictive barrier.

  21. Counterstrain • High Yield Targets: Tenderpoints Iliolumbar ligament, piriformis, hamstring • lumbar and sacral TP What is a tenderpoint? • Tenderpoints are small tense edematous areas of tenderness typically located near tendon attachments, ligaments, or in the belly of some muscles.

  22. Counterstrain • Jones Counterstrain = passive indirect technique • Muscle being treated is positioned at a point of balance or ease, away from the restrictive barrier. • “Fold and hold” for 90 sec • This is a neurosensory approach to the treatment of tenderpoints. • If you can put it into a position of comfort, you can probably treat it with counterstrain

  23. Facilitated Positional Release (FPR) • High Yield Targets: • SI-joint fascia, piriformis, lumbosacral junction • Indirect technique • Set up is similar to counterstrain • Add activating force (compression or distraction) • Takes 3-4 seconds to induce a release Great techniques for spine and joint dysfunctions

  24. Muscle Energy • High Yield Targets: • Iliopsoas, hamstring, quad, piriformis • anterior/posterior ilium, sacral torsion • lumbar segmental dysfunction • Muscle energy ~ “contract-relax” • Direct technique • Barrier engaged • Patient contracts against holding force • Relax, muscle lengthens • Engage a new barrier • Repeat

  25. High Velocity, low amplitude • High Yield Targets: • Anterior/Posterior sacrum or Ilium • Lumbar segmental dysfunction • Confronts restricted articulations “head on” • Don’t try it if you don’t know how • Barrier is engaged, fine-tuned in multiple planes to minute specificity • Final thrust in nearly ALL cases should be quick (high velocity) but short (low amplitude) • “shotgun” techniques are discouraged • Don’t do it if you don’t know how

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