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s: Treating Our Family & Yours 6th Annual OMT Seminar: January 24th, 2010
Core Concepts in Osteopathic Manipulative Medicine & The Application To Board Examinations
Michael P. Rowane, DO, MS, FAAFP, FAAO
Associate Clinical Professor of Family Medicine and Psychiatry Case Western Reserve University Director of Medical Education University Hospitals Richmond Medical Center Director of Osteopathic Medical Education University Hospitals Case Medical Center
Review core concepts of OPP/OMM/OMT Discuss general measures to prepare for board questions involving Osteopathic Principles & Practices [OPP] Examine the COMLEX Structural/OPP component to the National Board of Osteopathic Medical Examiners [NBOME] Present the 10 Basic Body Functions related to Osteopathic Manipulative Medicine [OMM] Explore the 5 Models involved in using Osteopathic Manipulative Treatment [OMT] Go over COMLEX practice questions involving OPP/OMM/OMT
Andrew Taylor Still, MD, DO
Born in 1828 Father = Minister & Physician MD in Kansas City, Mo Abolitionists, moved to Native American Reservation in Indiana Kansas Legislature Children died of meningitis MECHANICAL AGE Discovered Osteopathy 1874 American School of Osteopathy in Kirksville 1892
Definition: pathologic alteration of joint function mimic or aggravate organic disease involves “TART”
Tenderness Asymmetry altered Range of motion Tissue texture abnormality
Barriers To Motion Anatomic Physiologic Pathologic .
lacerations.Indications/Contraindications for Manipulation Indications: alleviate somatic dysfunction Contraindications: trauma (fractures. structural defects . bleeding pathologic bone disease (lytic / blastic) poor patient cooperation neurologic symptoms while positioning severe RA.
Indications/Contraindications of Manipulation Contraindications (cont.) Bruits in carotids Lens implants Hemophilia Medicolegal situations .
“Red Flags” = RIFT Radiculopathy Infection Fracture Tumor .
Types Of Manipulation: Direct/Indirect .
SOFT TISSUE TECHNIQUE DEFINITION: Procedure directed toward tissues other than skeleton while monitoring response and motion changes using diagnostic palpation. .
and/or separation of muscle origin and insertion. deep pressure.SOFT TISSUE TECHNIQUE (con’t) Usually involves lateral stretching. traction. linear stretching. .
A form of Osteopathic manipulative technique in which the patient uses their muscles. against a distinctly executed operator counterforce. . DO. Mitchell.MUSCLE ENERGY TECHNIQUE DEFINITION: A term first suggested by Fred L. on request. Sr. from a precisely controlled position. in a specific direction.
HIGH VELOCITY-LOW AMPLITUDE (THRUST) TECHNIQUE DEFINITION: A type of direct technique that uses high velocity-low amplitude forces. .
COUNTERSTRAIN TECHNIQUE DEFINITION: An indirect technique developed by Lawrence Jones. The operator moves the patient or part passively away from the motion barrier always searching for the position of greatest comfort. . DO.
COUNTERSTRAIN TECHNIQUE (con’t) Tender point associated with somatic dysfunction Patient is held in position of comfort for 90 seconds Physician brings patient back to neutral position Tender point is reassessed .
Jones Tenderpoints .
OTHER MANIPULATIVE TECHNIQUES OSTEOPATHY IN THE CRANIAL FIELD ARTICULATORY TECHNIQUE (Low Velocity-High Amplitude) BALANCE AND HOLD TECHNIQUE EXAGGERATION TECHNIQUE FIXED POINT ROTATION TECHNIQUE FUNCTIONAL TECHNIQUE GUIDING TECHNIQUE INHIBITORY PRESSURE TECHNIQUE FACILITATED POSITIONAL RELEASE .
OTHER MANIPULATIVE TECHNIQUES (con’t) MYOFACIAL RELEASE TECHNIQUE RANGE OF MOTION TECHNIQUE RESISTIVE DUCTION TECHNIQUE (Ruddi Technique) SPENCER TECHNIQUE SPRINGING TECHNIQUE (Low Velocity-Moderate Amplitude) TRACTION TECHNIQUE PROGRESSIVE INHIBITION OF NEUROMUSCULAR STRUCTURES (PINS) STILL’S TECHNIQUE .
BOTTOM LINE THERE ARE MULTIPLE MANIPULATIVE MODALITIES DIFFERENT CONDITIONS RESPOND TO DIFFERENT MODALITIES .
REFLEX ARCS VISCERO-SOMATIC REFLEX MI & arm pain SOMATO-VISCERAL REFLEX Fracture & vomiting SOMATO-SOMATIC REFLEX Tooth pain VISCERO-VISCERAL REFLEX MI & vomiting .
You must know all visero-somatic relationships to specific body systems & disease states REFLEX ARCS .
Recommended strategy to prepare for doing well on OMM/OMT section of the Complex/Specialty Board examinations. To review and discuss specific OMM/OMT questions that one may encounter on Complex/Specialty Board examinations. Objectives: To discuss salient topics that one must know to pass the OMM/OMT questions on Complex/Specialty Board examinations. .OMM Board Preparation Goal: To prepare the physician learner to successfully understand OMM/OMT questions on Complex/Specialty Board examinations.
.COMLEX Structural/OPP component Integrated within the fabric of the entire examination Osteopathic Principles and Practices [OPP] NOT only applicable to musculoskeletal problems Applicable to “human problems” All Body systems Various symptoms 15-20% of the exam is OPP-related This does not include OPP distractors throughout the examination.
Having self-healing and self-regulating capacities. Functioning better when there is normal inherent motion of the musculoskeletal and connective tissue structure .Osteopathically-Oriented Question! A DO view of the patient: A whole person of integrated body. mind & spirit Interactive and adapting to the environment as well as internal stressors Struggling to maintain the highest health status obtainable [usually] having functional problems interrelated with structural problems for which the patient is trying to compensate.
2.10 Basic Body Functions 1. 4. Posture and Body Movement Circulation Pulmonary Respiration Digestive. 3. 5. Absorption and Elimination Metabolism and Energy Balance .
.10 Basic Body Functions [con’t] Regulation of Fluid and Electrolyte Balance 7. Sensory Systems 9. Reproduction 10. Protective mechanisms 8. Consciousness and Behavior 6.
Consciousness and Behavior .5 Models: Using OMT Structural Model Posture & Body Movement Respiratory-Circulatory Model Metabolic Model Neurologic Model Sensory & Protective Behavioral Model Reproduction.
. keep in mind the different models that questions are based on.When reading questions.
Structural Model [Posture & Body Movement] Biomechanical adjustment Mobilization of Joints Remove restrictive forces & enhance Myofascial connective tissue Bony & soft tissues .
Structural Model [Posture & Body Movement] OMT Modalities HV-LA Muscle Energy Counterstrain Myofascial Release Ligamentous Articular Techniques Functional Techniques .
Respiratory-Circulatory Model Goal: Improve all diaphragm restrictors in the body Diaphragms “Transverse restrictors” of motion Venous drainage Lymphatic drainage CSF .
Diaphragms: “Conceptional Diaphragms” Plantar fascia Knee [popliteal fascia & cruciate] Pelvic Respiratory/T-L Diaphragm Thoracic Outlet [cervicothoracic] Suboccipital triangle Tentorium Cerebelli Diaphragm Sellae .
Respiratory-Circulatory Model OMT Modalities Osteopathy in the crainal field Myofascial Release Ligamentous Articular Techniques Lymphatic pump techniques .
Metabolic Model Enhance self-regulatory & self-healing mechanisms Enhance energy conservation Balance the body economy Energy expenditure Energy exchange Foster Immune enhancement Foster endocrine organ function enhancement .
Metabolic Model • OMT Modalities • Lymphatic pump techniques • Other osteopathically oriented management considerations: • Nutritional counseling • Diet • Exercise .
Neurologic Model [Sensory & Protective] Goals: Attain autonomic balance Address neural reflex activity Remove facilitated segments Decrease afferent nerve signals Achieve pain relief .
Neurologic Model [Sensory & Protective] OMT Modalities : Counterstrain Chapman’s Reflex points .
Emotional balancing Compensatory mechanisms Other items to consider Reproductive processes Behavioral adaptation/change . psychological. and social functional component of the health spectrum. Consciousness and Behavior] Goal: Improve the biological.Behavioral Model [Reproduction.
keep in mind the different models that questions are based on.When reading questions. .
Practice Questions .
release her diaphragm using myofascial release technique E. place the patient in the Trendelenburg position D. treat C6-C7 to affect the phrenic nerve . induce her labor with artificial rupture of the membranes C. In order to release her diaphragmatic pressure. All other tests appear normal. decrease her blood volume by initiating the use of furosemide B. the most appropriate management is to: A.1. Her lungs are clear to auscultation. A female at 34 weeks’ gestation presents with difficulty breathing while in the supine position.
place the patient in the Trendelenburg position D. A female at 34 weeks’ gestation presents with difficulty breathing while in the supine position. All other tests appear normal. Her lungs are clear to auscultation. induce her labor with artificial rupture of the membranes C. In order to release her diaphragmatic pressure. decrease her blood volume by initiating the use of furosemide B. release her diaphragm using myofascial release technique E. the most appropriate management is to: A.1. treat C6-C7 to affect the phrenic nerve .
T1-T5 T3-T9 lumbar sympathetic plexus suboccipital area superior cervical ganglion . E. osteopathic manipulative treatment intended to increase sympathetic stimulation to the lungs would be directed to which of the following areas? A.2. In a 22-year-old patient with asthma. D. B. C.
C. In a 22-year-old patient with asthma. D.2. T1-T5 T3-T9 lumbar sympathetic plexus suboccipital area superior cervical ganglion . B. osteopathic manipulative treatment intended to increase sympathetic stimulation to the lungs would be directed to which of the following areas? A. E.
C. A 53-year-old male presents to the office with severe numbness and tingling down the lateral aspect of the left arm to the thumb and the upper back. E.3a. The most likely diagnosis is A. D. B. and no trauma is recalled. anterior disk herniation brachial plexopathy foraminal encroachment from osteoarthritis posterior cervical muscle strain spinal cord tumor Question 1 of 2 in set . This began insidiously one month ago.
This began insidiously one month ago. The most likely diagnosis is A. C. B. A 53-year-old male presents to the office with severe numbness and tingling down the lateral aspect of the left arm to the thumb and the upper back. D. anterior disk herniation brachial plexopathy foraminal encroachment from osteoarthritis posterior cervical muscle strain spinal cord tumor Question 1 of 2 in set .3a. E. and no trauma is recalled.
3b. D. E. The nerve root most likely involved in this presentation is A. C4 C5 C6 C7 C8 Question 2 of 2 in set . B. C.
” .“…severe numbness and tingling down the lateral aspect of the left arm to the thumb and the upper back.
D. The nerve root most likely involved in this presentation is A. C.3b. C4 C5 C6 C7 C8 Question 2 of 2 in set . B. E.
A patient presents with vertigo. D. B. ethmoid maxilla parietal sphenoid temporal . E. C. A. Dysfunction of which of the following cranial bones is most likely involved? 4.
Inner Ear & Temporal Bone .
E. B.A patient presents with vertigo. ethmoid maxilla parietal sphenoid temporal 4. D. C. Dysfunction of which of the following cranial bones is most likely involved? A. .
Summary Reviewed core concepts of OPP/OMM/OMT Discussed general measures to prepare for board questions involving Osteopathic Principles & Practices [OPP] Examined the COMLEX Structural/OPP component to the National Board of Osteopathic Medical Examiners [NBOME] Presented the 10 Basic Body Functions related to Osteopathic Manipulative Medicine [OMM] Explored the 5 Models involved in using Osteopathic Manipulative Treatment [OMT] Went over COMLEX practice questions involving OPP/OMM/OMT .
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