What is a D.O.?
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Transcript What is a D.O.?
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 rights
1967 – 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. schools
137 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 Medicine
D.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 Medicine
D.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 dysfunction
Impaired function of the body
framework
Treatable using OMT
Described 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 stretching
Lengthening linear/band muscles
Gentle technique
Can be performed on acute injuries
Terminology - Treatment
Effleurage
Gentle technique
Improves lymphatic flow
Reduces sympathetic tone to the area
Lymphatic pump
Generally gentle
Improves lymphatic flow
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
Terminology - Treatment
Muscle Energy
Take dysfunction to barrier
Resist movement away from barrier
Repeat
Works for small or large areas
Gentle technique
Terminology - Treatment
High Velocity Low Amplitude (HVLA)
Takes an area of dysfunction to a
barrier
Thrusting 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
Secondary
Sinus related
Vascular (AVM, aneurysm)
Post trauma
Structural or metabolic derangements
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
Acute Treatment Plan
Treat rapidly
Restore patient’s function
Optimize self-care
Minimize side effects
Acute Treatment – TTH
Aspirin
Acetominophen
NSAIDs
Ibuprofen, Ketoprofen, Naproxen
Ketorolac
Combinations with caffeine
Excedrin Migraine, Advil Migraine
Acute Treatment – TTH
Butalbital or codeine combos
Triptans, Muscle relaxants
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)
Not effective in pure TTH
Other methods
OMT
Ice, biofeedback
Preventive Treatment – TTH
Amitriptyline
SNRIs
Mirtazipine
Venlafaxine
SSRIs – no benefit over placebo
Anticonvulsants – limited data
Gabapentin
Topiramate
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 techniques
Counterstrain
OA / Cervical
Muscle Energy
OA / Cervical Spine / rhomboids
Scalenes
HVLA
Lumbar roll
Questions?