Introduction to Osteopathic Medicine

1. Introduction to Osteopathic Medicine Ronald Januchowski, D.O. Associate Dean, VCOM

2. Objectives • Review the history of Osteopathic Medicine • Introduce / review some common techniques • Practical applications

3. 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 rights • 1967 – draft extends to D.O. • 1973 – full practice rights in all 50 states

4. 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

5. History of Osteopathic Medicine • Evolution of mission and identity

6. History of Osteopathic Medicine – Growth FIRST YEAR ENROLLEMENT IN D.O. SCHOOLS

7. History of Osteopathic Medicine – Growth • Medical schools in the U.S. • 34 D.O. schools • 137 M.D. schools

8. 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%

9. History of Osteopathic Medicine D.O. vs. M.D.’s D.O. M.D. 4 years of medical school Residency training Licensing exam Unlimited medical practice Use of medicines and/or surgery • 4 years of medical school • Residency training • Licensing exam • Unlimited medical practice • Use of Osteopathic Manipulative Treatments in addition to medicines and/or surgery

10. History of Osteopathic Medicine D.O. vs. Chiropractors D.O. Chiropractic Medicine 4 years of chiropractic school Use of spinal adjustment is main method of treatment Limited practice licensure • 4 years of medical school • Manipulation as one method of many treatment methods • Fully licensed, unlimited practice physicians

11. Terminology - Diagnosis • Somatic dysfunction • Impaired function of the body framework • Treatable using OMT • Described using • Position of the part • Direction which motion is best or limited • TART

12. Terminology - Treatment • Soft tissue techniques • Effluerage / lymphatic techniques • Counterstrain • Muscle Energy • HVLA

13. Terminology – Treatment • Soft tissue stretching • Lengthening linear/band muscles • Gentle technique • Can be performed on acute injuries

14. Terminology - Treatment • Effleurage • Gentle technique • Improves lymphatic flow • Reduces sympathetic tone to the area • Lymphatic pump • Generally gentle • Improves lymphatic flow

15. Terminology – Treatment • Counterstrain • Gentle technique • Find a dysfunction and place the area in a position of comfort • Hold for 90 seconds and return to neutral position

16. Terminology - Treatment • Muscle Energy • Take dysfunction to barrier • Resist movement away from barrier • Repeat • Works for small or large areas • Gentle technique

17. Terminology - Treatment • High Velocity Low Amplitude (HVLA) • Takes an area of dysfunction to a barrier • Thrusting through the functional barrier to improve movement

18. Headaches in History

19. Headaches in History

20. Headache Types • Primary • Migraine (with and without aura) headache • Tension-type headache • Cluster headache • Secondary • Sinus related • Vascular (AVM, aneurysm) • Post trauma • Structural or metabolic derangements

21. Exam findings • Structural exam findings • C1-C3 somatic dysfunction • Tender points in particular headaches • Frontal & orbital (C1, occipitomastoid) • Periorbital (C2, occipitomastoid, infraorbital and nasal) • Occipital (C4) • Motion restrictions in OA area • Scapular / upper thoracic dysfunction • Sacral dysfunction sometime involved

22. Acute Treatment Plan • Treat rapidly • Restore patient’s function • Optimize self-care • Minimize side effects

23. Acute Treatment – TTH • Aspirin • Acetominophen • NSAIDs • Ibuprofen, Ketoprofen, Naproxen • Ketorolac • Combinations with caffeine • Excedrin Migraine, Advil Migraine

24. 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 relaxants • Not effective in pure TTH • Other methods • OMT • Ice, biofeedback

25. Preventive Treatment – TTH • Amitriptyline • SNRIs • Mirtazipine • Venlafaxine • SSRIs – no benefit over placebo • Anticonvulsants – limited data • Gabapentin • Topiramate

26. 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

27. Osteopathic techniques for headache treatment • Soft tissue techniques • OA / Cervical Spine / rhomboids • Counterstrain • OA / Cervical • Muscle Energy • Scalenes • HVLA • Lumbar roll

28. Questions?