Introduction to Osteopathic Manipulative Medicine (OMM) and Palpation

Amy Vagedes OMSVTherese Obioha OMSVJune 5, 2013Original presentation by:P. Ackerman, T. Neely, K. Ritchey, July 9, 2009

Lecture Topics What is a D.O.? D.O. Education What is OMM? Six Clinical Considerations The Osteopathic Exam

Who is a D.O? We are certified physicians, with separate

but equal rights as allopathic physicians (M.Ds)

We have practice rights in all 50 states, and internationally (in New Zealand, China, Canada, Russia and more)

Dr. Eland Teaches our techniques in Germany

International Practice Rights

http://en.wikipedia.org/wiki/File:DOworld.PNG

The D.O. Education Focus on Anatomy, Physiology and the

musculoskeletal system Integrative/ Whole Person Approach Our education

4 year professional degree 2 years classes:

Lecture and Small group tracks (Tas CPC experience. Amy and Therese PCC experience)

OMM Lab: 200 hours of hands-on education 2 Years of hospital based clinical training

The D.O. Education

4 Osteopathic Principles / Concepts:

1. The body is a unit

2. The body is capable of self-regulation, self-healing, and health maintenance.

3. Structure and function are reciprocally interrelated.

4. Rational treatment is based upon the preceding three principles.

What is OMM? Osteopathic Manipulative Medicine Using the hands as a diagnostic and

treatment tool Training the students to be a consistent and

reproducible practitioners A skill that takes time and practice, like

listening for heart sounds or suturing Objective findings of bone, muscles, joints

and their relationship to the rest of the body

What is OMM? Examples of what we feel with our hands:

Bogginess Thickening Stringiness Ropiness Firmness (hardening) Increased / Decreased Temp Incr. / Decr. Moisture

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Six Clinical Considerations1. Fluid Congestion

2. Sympathetic Nervous System

3. Parasympathetic Nervous System

4. Pain Considerations

5. Biomechanical Concerns

6. Psychosocial Concerns

Six Clinical Considerations #1Fluid Considerations: Venous Lymphatic

accumulation of tissue fluid.

inability of the drainage system to cope with excess fluid.

Six Clinical Considerations

Lymphatics are the ‘Overflow system’ of the body.

Local drainage or lack thereof is only one component in the equation of fluid build up.

Key Principle: Any blockage along the pathway of excess fluid will inhibit its drainage.

Clinically Oriented Anatomy, 5th Ed., p.45

Six Clinical Considerations #2Sympathetic Nervous System The afferents affect the

cord level at which they enter, so there is influence on: Internal organs Musculoskeletal system Blood vessel constriction

Clinically Oriented Anatomy, 5th Ed., p.63

Six Clinical Considerations “Hypersympathetic activity is a common

factor in disease.”

Irvin Korr, PhD.

-one of the pre-eminent physiologists who has worked and performed research within the Osteopathic profession.

Parasympathetic Nervous System #3 Cranial Nerve X is

a primary source for visceral innervation

The sacral level is another important source.

Clinically Oriented Anatomy, 5th Ed., p.65

Six Clinical Considerations #4

Pain Pathways Pain fibers follow the course of

the mixed spinal nerves Local inflammation will

prolong the pain fiber stimulation.

Facilitation in the nervous system will amplify the experience of pain

Clinically Oriented Anatomy, 5th Ed., p.56

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Six Clinical Considerations #5 Biomechanical Concerns:

All of these stuctures course through the myo-fascial (muscles & fascia) system.

Disruption (torques, twist, strains) can cause sub-optimal function

#6 Psychosocial Concerns: Psychosomatic relationship of pain Integrative approach

The Osteopathic Exam Key to any diagnostic test is

Consistency & Reproducibility

We teach a Protocol for musculoskeletal diagnosis This is the basis for the Screen, Scan, Segmental

Definition Model We will teach this method in the next lecture/labs

The Osteopathic Exam – Musculoskeletal Diagnosis

SCREEN

(Level 1)

General Impression

Is there a problem?

What regions exhibit a problem?

SEGMENTAL DEFINITION

(Level 3) Diagnostic

Characteristics

What?

What are the specific characteristics of the identified segment(s)?

SCAN(Level 2)

Location

Where?

Which mobile segment(s) in an identified region is(are) involved?

Lecture Summary D.Os are full physicians with national and

international practice rights Four Osteopathic Principles Osteopathic Manipulative Medicine Six Clinical Considerations The hand as a diagnostic tool Consistency & Reproducibility

Questions?

Break- Next is Lab

Palpatory Lab Lab Expectations Professional Touch Dominant Eye Palpatory Skills Palpatory Exercises:

Coins Layered Palpation- arm Motion Palpation- Spine

Lab Expectations Attire:

Shorts, t-shirts or tank tops Please take off shoes No rings or hook earrings

Leave Bags, books and other items in locker room

Please replace stools & pillows under tables after lab

Professional Touch Be respectful Be mindful of your

hands Be aware of your

partners level of comfort

Ask about any cultural or religious preferences

Dominant Eye Look at an object ie. The clock Make a triangle/circle with hands around

the object Make sure you are focused on the object Alternate closing the left and right eyes; if

the object moves that is your non-dominant eye

Palpatory SkillsAbility to Detect

Tissue Texture Abnormality Asymmetry of position Differences of movement Sense position in space Change in palpatory findings (improvement

and worsening)

Palpatory Skills

T.A.R.T. S.T.A.R. T

Tenderness A

Asymmetry R

Range of Motion T

Tissue Texture changes

S Sensitivity

T Tissue Texture

A Asymmetry

R Range of Motion

Palpatory Skills

Examples Superficial/Deep Compressible/Rigid Warm/Cold Moist/Dry Painful/Pain free Local or or widespread Relaxed/Tense Hypertonic/Hypotonic

Palpatory Exercise- Coins Pass the Coins, please.

Close your eyes. Using the pads of each of your fingers

explore the contours of the coin. What is the shape, size? What denomination is the coin? Can you determine which is heads/tails?

Palpatory Exercise- Coins Place coin under sheet of paper

Can you feel the coin? Can you feel it move If this is too easy, use more layers of paper

OR Advanced: Place strand of hair under page

in phone book. Can you feel it? Keep increasing pages for difficulty

Palpatory Exercise- Layered Palpation

Use your own forearm. Use the finger pads of one hand to explore

the characteristics of the opposite forearm. Skin Muscle Blood Vessels Bone Layers in between

Can you feel my PULSE Doc? Palpatory exercise:

Palpate your partner’s radial pulse with two fingers (besides your thumb-anyone know why???)

Appreciate the pulse Gently apply pressure until you no longer feel

a pulse Now, gently release the pressure until you can

appreciate the pulse once more.

Palpatory Exercise- Spine Partners Place your hands on

middle of back Feel for Spinous

Process Move about 2 cm

laterally- you should feel the transverse processes

Does one side feel more prominent than the other?

Have partner do the following motions Flexion Extension Sidebending Rotation

Do you feel change?

Switch Partners

Questions???

If time-LET’S PLAY ?

Laboratory Summary Lab Expectations Professional Touch & Dominant Eye Palpation Skills Palpatory Exercises

Practice !!

Next Lecture: The Osteopathic Exam: Screen, Scan and Segmental Definition

Thank-you ANY Questions?

OMM Fellows

Fellowso@oucom.ohiou.edu