WINTER OMT Update - February 3-4, 1996 (Intermediate Course) "Application of Osteopathic Concepts in Clinical Medicine and Preparation for OMM Boards" Deadline for Advance Registration: Program Chairperson: January 1, 1996 Melicien Tettambel, DO, F AAO ,------7 I Wint,erOMTUpdate I Location: : Registration Airport Holiday Inn; Indianapolis, IN I February 3-4, 1996 I Holiday Inn Airport I Indianapolis, Indiana Saturday, February 3 Sunday, February 4 I 7:30 am Thoracic Spine & Ribs 1------:------;--:-- 7:30 am Course Overview IName for Badge (please print clearly) Elaine M. Wallace, DO I 8:00 am HVLA 9:00 am Catherine M. Kimball, DO The Extremities Istree t Address for Confirmation Theresa Cisler, DO I 8:45 am Muscle Energy 10:30 am Melicien Tottambel, DO, FAAO OMT in OB/Gyn : City State Zip Melicien Tottambel, DO, FAAO I 9:30 am Counterstrain 11:30 am OMT in Pediatrics Elaine M. Wallace, DO I Daytime Phone Number Theresa Cisler, DO I 10:15 am Small Group Discussion 1 _ ...:;__::::.....= =---:.;;..:__ -=-----= 12:30 ___ pm Lunch iAOA Number 10:25 am • Myofasical Release 1:00 pm OMT in Geriatrics I Melicien Tottambel, DO, FAAO Catherine M. Kimball, DO I College and Year Graduated 11:15 am Cranial Osteopathy I 2:00 pm My Favorite Technique Theresa Cisler, DO Panel and Audience ISEMINAR FEE: I 12:30 Lunch pm 3:00 pm Summary !Prior to January 1, 1996: Questions & Ansers IAAO Member $475 1:00 pm Building and Promoting OMT Practice I Intern/Resident $250 3:30 pm Adjourn Panel 1AAO Non-Member $525 I 2:00 pm Cervical Spine I After January 1, 1996: Elaine M. Wallace, DO CME Hours: AAO Member $575 2 Days - 18 Category 1-A I Intern/Resident $350 3:30 pm Lumbar Spine and Pelvis :AAO Non-Member $625 Catherine M. Kimbell, DO Course Objectives: This Academy program is designed for I 5:00 pm OMM Board Applications & the physician desiring the following: I Case Studies . OMT Review: Hands -on experience Hotel Reservations: Facu lty and troubleshooting I Holiday Inn Airport • Integration of OMT in treatment of I 2501 South High School Road 6:30 pm Adjourn various cases I Indianapolis , Indiana 46241 • Preparation for OMT practical por I (317) 244-6861 tions of certifying boards I Beat the Deadline - FAX to: • Preparation for AOBSPOMJ.VI(Ameri $ 79.00 single/double American Academy of Osteopathy can Osteopathic Board of Special Profi I (317) 879-0563 ciency in Osteopathic Manipulative Medi IL _ _ _ _J cine) ______
2/AAO Journal Winter 1995 A.American 1HEAAO Academy of Osteopathy -"''~"~""'"~·---,·""'-"' 3500 DePauw Boulevard J I Suite 1080 The mission of the American Academy of Osteopathy is to teach, explore, j. Indianapolis, fN 46268-1136 advocate, and advance the study and application of the science and art of (317) 879-188 I total health care management, emphasizing osteopathic principles, FAX (3 17) 879-0563 palpatory diagnosis and osteopathic manipulative treatment.
1995-1996 From the Edi tor ...... 5 BOARD OF TRUSTEES by Raymond J. Hruby, DO, FAAO President Message from the President ...... 6 Boyd R. Buser, DO by Boyd R. Buser, DO President Elect Michael L. Kuchera, DO, FAAO Message from the Executive Director ...... 7 Immediate Past President by Stephen J. Noone, CAE Eileen L. DiGiovanna, DO, FAAO Calendar Events ...... 8 Secretary-Treasurer of Anthony G. Chila, DO, FAAO Osteopathic Medicine: The Three Diminsional Approch ...... 9 Trustee Mark S. Cantieri, DO by Stephen J. Blood, DO, F AAO
Trustee Letter to A. T. Still ...... 13 John C. Glover, DO by Raymond J. Hruby, DO, FAAO Trustee Ann L. Habenicht, DO Dr. DiGiovanna Named "NOF/AOA Educator of the Year" ...... 13 Trustee Letters to the Editor ...... 14 Judith A. O'Connell, DO, FAAO
Trustee Structural and Hormonal Influences on Pelvic Mechanics ...... Karen M. Steele, DO, FAAO in Labor and Delivery ...... 17 Trustee by Melicine Tettambel, DO, FAAO Melicien A. Tettambel, DO, FAAO From the Archives ...... 24 Executive Director Stephen J. Noone, CAE by Carl P. McConnell, DO AAO Case Study, "Trigeminal Neuralgia" ...... 25 Editorial Staff by David Coffey, DO, CSPOMM
Editor-in-Chief ...... Raymond J. Hruby, DO, FAAO Manipulation of the Eustachian Tube ...... 27 Supervising Editor ...... Stephen J. Noone,CAE by J. Scott Heatherington, DO
Editorial Board ...... Barbara J. Briner, DO In Memoriam ...... 28 Anthony G. Chila, DO, FAAO Rachel (Woods) Harwood, DO James Norton, PhD Frank H. Willard, PhD Classifieds ...... 31 Managing Editor ...... Diana L. Finley Journal Index (1991-1995) ...... 32
The AAO Joumid is the official quarterly publication of the American Acad emy of Osteopathy (3500 DePauw Blvd., Suite 1080, Indianapolis, lndi Advertising Rates for the AAO Journal ana, 46268- 1136). Third-class )JOSI.age paid at Carmel, TN. Postma.liter: Send address changes 10Americ~n At:ademy of Osteopathy 3500 DePauw Blvd., An Official Publication of The American Academy of Osteopathy Suite 1mm, Indianapolis, TN., 46268-1136 The AOA and AOA affiliate organizations and members of the Academy The A.AO Joumal is not itself responsible for statements made by any con tributor. Although all advertising is ex.peered to conform to ethical medical are entitled to a 20% discount on advertising in this Journal. s1andards, acceptance does not imply endorsement by this journal. Opinions expressed in The AAO Journal are those of authors or speakers Call: The American Academy of Osteopathy and do not nec:,essarily reflect viewpoints of the editors or official policy of the American Academy of Osteopathy Qr the iustitutions with which the (317) 879-1881 for an Advertising Rate Card authors arc affiliated, unless specified.
Subscriptions: $25.00 per year
Winter 1995 AAO Joumal/3 Instructions for Authors
The American Academy of Osteopathy Submission Illustrations (AAO) Journal is intended as a forum for Submit all papers to Raymond J. Hruby, 1. Be sure that illustrations submitted are disseminating information on the science DO, FAAO, Editor-in-Chief, MSU-COM, clearly labeled. and art of osteopathic manipulative medi Dept. of Biomechanics, A-439 E. Fee Hall, cine. It is directed toward osteopathic phy East Lansing, MI 48824. 2. Photos should be submitted as 5" x 7" sicians, students, interns and residents and glossy black and white prints with high con particularly toward those physicians with a Editorial Review trast. On the back of each, clearly indicate special interest in osteopathic manipulative Papers submitted to The AAO Journal the top of the photo. Use a photocopy to treatment. may be submitted for review by the Edito indicate the placement of arrows and other The AAO Journal welcomes contribu rial Board. Notification of acceptance or re markers on the photos. If color is necessary, tions in the following categories: jection usually is given within three months submit clearly labeled 35 mm slides with after receipt of the paper; publication fol the tops marked on the frames. All illustra Original Contributions lows as soon as possible thereafter, depend tions will be returned to the authors of pub Clinical or applied research, or basic sci ing upon the backlog of papers. Some pa lished manuscripts. ence research related to clinical practice. pers may be rejected because of duplication of subject matter or the need to establish 3. Include a caption for each figure. Case Reports priorities on the use of limited space. Unusual clinical presentations, newly Permissions recognized situations or rarely reported fea Requirements Obtain written permission from the tures. for manuscript submission: publisher and author to use previously pub lished ilJustrations and submit these letters Clinical Practice Manuscript with the manuscript. You also must obtain Articles about practical applications for 1. Type all text, references and tabular written permission from patients to use their general practitioners or specialists. material using upper and lower case , photos if there is a possibility that they double-spaced with one-inch margins. might be identified. In the case of children, Special Communications Number all pages consecutively. permission must be obtained from a parent Items related to the art of practice, such or guardian. as poems, essays and stories. 2. Submit original plus one copy. Please retain one copy for your files. References Letters to the Editor 1. References are required for all mate Comments on articles published in The 3. Check that all references, tables and rial derived from the work of others. Cite AAO Journal or new information on clini figures are cited in the text and in numeri all references in numerical order in the text. cal topics. Letters must be signed by the cal order. If there are references used as general source author(s). No letters will be published material, but from which no specific infor anonymously, or under pseudonyms or pen 4. Include a cover letter that gives the mation was taken, list them in alphabetical names. author's full name and address, telephone order following the numbered journals. number, institution from which work initi Professional News ated and academic title or position. 2. For journals, include the names of all News of promotions, awards, appoint authors, complete title of the article, name 5. Manuscripts must be published with the ments and other similar professional activities. of the journal, volume number, date and correct name(s) of the author(s). No manu inclusive page numbers. For books, include scripts will be published anonymously, or Book Reviews the name(s) of the editor(s), name and lo under pseudonyms or pen names. cation of publisher and year of publication. Reviews of publications related to os Give page numbers for exact quotations. teopathic manipulative medicine and to Computer Disks manipulative medicine in general. We encourage and welcome computer Editorial Processing disks containing the material submitted in All accepted articles are subject to copy Note: Contributions are accepted from hard cop y for m. Th ough we prefer editing. Authors are responsible for all state members of the AOA, faculty members in Macintosh 3-1/2" disks, MS-DOS formats ments, including changes mad e by the osteopathic medical colleges, osteopathic using either3-J/2" or 5-1/4" discs are equally manuscript editor. No material may be re residents and interns and students of osteo acceptable. printed from The AAO Journal without the pathic colleges. Contributions by others are written per mission of the editor and the accepted on an individual basis. author(s).
4/AAO Journal Winter 1995 From the Editor by Raymond J. Hruby, DO, FAAO
In the Company of Giants r I dispense with my usual philosophical lessons in favor of the trumpet, which he ramblings here in order to dedicate this felt was better for his overall health, issue's Editorial Page to some words especially since he suffered from about a couple of important people. You pulmonary problems. This led to an are all aware by now that in recent months interest in the health and occupational two long-standing members of the problems of musicians, and Vic was Academy, both giants in our profession, extremely knowledgeable in the area of have passed away. Vic Hoefner, DO, music medicine. I learned a great deal FAAO, passed away in August of this from him about the application of year from injuries sustained in a fall osteopathic principles in the areas of from his horse. Additionally, I exercise and music medicine. understand that John Harakal, DO, Anyone who has ever even heard of FAAO, died while working in his yard at John Harakal knows of his lifelong home. dedication to the work ofWilliam Garner The news of the passing of these two Sutherland, and his work with the fine human beings appears in the AAO Sutherland Cranial Teaching Foundation Newsletter, so I will not repeat any of and The Cranial Academy. He was also that information here. But, I do want to well known for his professional say a few words about Vic and John, contributions through the Educational Sponsored by: AAmeriean partly because of the status they held Council on Osteopathic Principles, the Academy of within the Academy, and especially National Board of Osteopathic Medical Osteopathy because I knew them both well and Examiners and his teaching at the Texas because they both had a great influence College of Osteopathic Medicine. To For a $15 enrollment fee on me. Whenever I had a chance to be me, he had a most interesting way of you and your family members around them I knew I was in the company thinking about almost everything. He can receive of giants. had, in my opinion, an amazing grasp of replacement contact lens Vic Hoefner was exemplary in his osteopathic principles and osteopathic at up to 75%discount! osteopathic practice, his teaching and thinking, and I always enjoyed learning Call the AAO his dedication to the Academy and the more and more from him how he applied for an enrollment profession. His background in this thinking to his everyday life. John form today! anesthesiology allowed him to write was also one of the members of the (317) 879-1881 several articles on the application of Board on Fellowship who tested me osteopathic principles to this field of when I received my Fellowship in the practice. Vic's childhood illnesses led Academy. gatherings, I constantly remind myself him to pursue a strong interest in physical I will miss both of these individuals, that I am among the giants of our fitness, especially gymnastics. He used as will we all. I will miss them for their profession. When I am around students these activities to build up his body and knowledge, their humor and their I am aware they are the giants of the provide himself with a long and healthy gentlemanly natures. They were both future. We have so much to learn from life. His interest in these areas led him to truly giants among us. each other and so much to give to each design exercise programs especially All of this makes me think that we all other. We should not waste a moment of suited to senior citizens, and he developed sometimes forget about the opportunities these precious opportunities, especially video tapes to demonstrate his programs. and blessings that surround us until they when we are in the company of giants. As a child he turned away from piano are gone. Whenever I am at Academy D Winter 1995 AAO Journal/5
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Southeastern Contact: The Northup Lecture . Medicine: received extensive exposure and osteopath\C debate within the American Academy of Family Physicians. * Insurancecompanies and the public have received positivereinforcementforthe use and benefits of manipulation through the guidelines for the treatment of acute low back pain. * Congress defeated a bureaucratic managed health care system. * CPT codes for manipulation performance by DOs now exist. • Editor's Note: been inspired by the wisdom of previous * New research at the University of Stephen D. Blood, DO, F AAO, made lecturers - my mentors - and today, I Maryland has established a link between the following presentation at the Thomas hope to honor them. the cervical spine, its dura and headaches. L. Northup luncheon during the Although I never knew Dr. Thomas * Osteopathic medical colleges have convention of the American Osteopathic Northup, this Academy's founder, Ionce had a banner year with more than 20,000 Association on October 18, 1995. heard him speak at an AOA meeting by applications. Dr. Blood received his Doctor of telephone link. By reputation, he was a * Dr. Andrew Weil' s book , Osteopathy degree from Kirksville leader, a pillar in our profession and a Spontaneous Healing, has generated new College of Osteopathic Medicine, where man of great integrity. public interest in manipulation. he was active in and President of the As a group, the Northup speakers Hopefully, our Academy, our UAAO. He served his internship at the have acknowledged many needs: better educational institutions and our Osteopathic Hospital of Maine in integration of osteopathic theory and profession will be able to successfully Portland and is a Diplomate of the practice in all our basic science and meet the challenges represented by such National Osteopathic Board of clinical rotations; the critical need for increased exposure and demand. Examiners. more osteopathic research and more Dr. Andrew Taylor Still, our founder, He is a fellow of the American published articles on osteopathy in a conceived of osteopathic medicine as a Academy of Osteopathy, is certified by clinical setting. I agree 100 percent with body, mind and spirit approach to health the American College of General their assessments. care - a concept which has withstood Practitioners in Osteopathic Medicine Our Academy has made several the test of time. My presentation today is and Surgery and has completed the important advances in recent years. Our an effort to expand our understanding Competency Exam given by The Cranial educational offerings have been and treatment of the patient with this Academy. expanded. We have made a significant three-dimensional approach. Since 1968, Dr. Blood has served on impact on the AOA and our colleagues. Although the DOs who use numerous boards and committees and The profess ion recognizes our manipulation have had a good year, the has been active in such programs as the proficiency examination in osteopathic practice of whole-person medicine is Visiting Clinicians and Golden Ram diagnosis and treatment. We now have a involved in an ongoing struggle. Programs since their inception. professionally-staffed, permanent home Boasting of its "efficiency" and "cost in Indianapolis. We have enlightened containment", managed care programs leadership. are undermining historically beneficial I am honored to have been chosen by This past year has been a good one for aspects of the doctor-patient relationship. my peers to deliver this Thomas L. DOs who administer manipulation: Doctor-patient time is reduced, limiting Northup Lecture. For 20 years I have * Osteopathic manipulation has the primary care physici ans' ➔
Winter 1995 AAO Journal/9 opportumties to get to know their both anatomical and philosophical percent of the body's bulk.3 I know Dr. patients. The patient may not necessarily principles.2 Still would be pleased to see how Dr. see the same doctor or even the same For medicine to be truly successful, it Sutherland's cranial concept and the nurse-practitioner on consecutive visits. must do more than attempt to relieve or recent development of visceral And, at the end of the contract year, the remove the symptoms. Osteopathic manipulation have increased that 60 employer may change "health providers" diagnosis and treatment of the whole percent bulk of the body now available by awarding the contract to a lower patient is fundamental in treating for treatment. bidder. preventively. Preventative treatment is Osteopathic diagnosis and treatment In spite of this market-driven health more than just keeping up with play a positive role in the prevention or care system crossing the country like a immunizations! treatment of most musculoskeletal tidal wave, pockets of osteopathic The whole patient approach includes disorders, and can alter, if not resolve, primary care physicians are still thriving consideration of the patient's education, many functional and pathological and continue to practice the art of treating environment, mental health, economics, processes in the body. The osteopathic patients three-dimensionally. The exercise, nutrition, religion and other manipulative treatment has many goals: common denominator for these DOs is circumstances which influence physical to remove the facilitated segment; to the need to know and listen to their disorder, recovery, health, productivity, rebalance the autonomic nervous system; patients. Osteopathic diagnosis and happiness and wholeness. to prevent, decrease or resolve visceral treatment are integral parts dysfunction; to regain normal of treating the whole person. range of motion of joints and THEWHOLE PERSON: The history of this THEBODY fascia; to reduce pain; to philosophical approach to _,, '- improve posture; to restore healing is rooted in ancient circulation; to promote axial times. Early philosophers t:: plasmic flow; to move body and physicians taught their cc fluids; to improve breathing and ii: z students that man must be en cc relaxation and to create a tonic considered in the totality of / • :E I ' cc effect. his composite body. The • w Outside the osteopathic Cl z physical body, mind and soul z !: profession, Dr. Still's basic comprised a unified human i concepts have not yet received biological unit. This the attention and objective ♦ / ..... philosophy was a • z scrutiny they deserve. This is fundamental principle in the l BODY ! cc most unfortunate, if not ► lnvolunlaryResponses: VoluntaryRnponsn: :E school of medicine founded Cl 4 0 Sympathetic Behavioral cc scientifically unconscionable. a::I Parasympath1llc Musculo1k1letaI w by Hippocrates who became Immunologic I It is even more unfortunate that, Endocrine ::, known as the Father of BasalGan g Ila (lnvolunta ry MuscleT1n1lon 0 at this stage of our osteopathic Medicine. medical evolution, many of our Almost 2,400 years after own have lost sight of the Hippocrates lived, Dr. Still championed In approaching the physical body, the genius in Dr. Still' s basic concepts and a medical philosophy which was more first dimension of the whole person, the their beneficial application to patients. in tune with Hippocrates than any other body frequently reveals its history and Let's tum to the inner man, comprised 19th Century approach. Dr. Still physical with gentle diagnostic listening of mind and spirit. In the Greek New concurred with Hippocrates that a doctor through the operator's hands. With a Testament, the mental, or psychological should focus on the patient rather than "tissue diagnosis", treatment can be dimension of a person, is known as the the disease. Historically, medicine has administered with appropriate guided psyche. The mind, or soul, imparts unique been considered more "science" than force to match tissue resistance and elements to each individual, including philosophy. 1 accomplish goals set for that visit. personality. The mind has three In Dr. Still's day, medicine was a Dr. Still advocated that physicians functions: intellect, emotions and will. series of arbitrary remedies, often more revive proper circulation by working The mind also monitors the autonomic destructive than the disease allegedly with the musculoskeletal system. He nervous system. Our mind enables us to being treated. Dr. Still was unique in believed it would be an obvious and comprehend and analyze data from our recognizing the ineffectiveness of these gross omission in patient treatment to environment, as perceived by the five medical treatments and the need for a ignore or slight the musculoskeletal senses. We also have tremendo us basic medical philosophy founded on system which comprises more than 60 creative potential to understand complex
10/AAO Journal Winter 1995 and abstract ideas. analysis. If a situation is perceived as Recently, Dr. Larry Leshan identified The creative and spiritual aspects of threatening, information may move classic examples of mind-body our being set us apart from all other life directly from the thalamus to the responses. In his study a majority of on earth. Our memory empowers us to amygdala, a tiny, almond-shaped cancer patients had suffered a devastating reflect on the remote past and anticipate structure called "emotion central" by personal loss in the year prior to being the distant future, giving us the unique some scientists. It quickly assesses a diagnosed with cancer, causing them to ability to worship God.5 situation and may produce a primitive feel they had lost their central reason for In our minds, each of us has a belief reaction of fear of anxiety, sending that living. Of the cancer patients studied by system, which greatly influences our message on to the cortex for further Dr. Leshan, more than 75 percent had emotions, will, speech and behavior. thinking and memory enhancement. It such a pattern of loss versus only 12 This is the core of what we hold to be may set in motion basic involuntary percent in a healthy control group. true about ourselves and the world around bodily responses throughout the Another pattern observed in cancer us. Our beliefs are shaped first by our sympathetic memory systems. In patients was a lifelong difficulty in parents and later by teachers, peers, essence, we feel before we think. openly expressing theirneeds as well as television, church, music and a host of The third function of our minds, the a tendency to repress anger and other other influences. We refine our beliefs human will, is to make choices of thought, strong negative feelings. Such behavioral as we mature and begin to think for word and action. Our wills are driven to patterns were evidenced in nearly half ourselves; yet early influences can be varying extents by our motives, and the of the cancer patients studied, compared powerful and difficult to change. intensity of a motive determines the with 25 percent of those in a healthy The second function of our minds is intensity of our emotions when our will control group. to experience emotions. Pleasurable has been thwarted. Our wills often Over a period of 20 years, Dr. emotions help us to enjoy intimacy with determine our beliefs and behavior. As Leshan' s "crisis therapy" helped 70 God and others, whereas painful an old saying goes, "When you have a cancer patients identify positive aspects emotions serve to warn us about hammer in your hand, everything looks of their lives, instilling in them the unresolved psychological or spiritual like a nail." We tend to see and believe importance of self-acceptance and self problems in the same way that physical what we want or expectto see and believe. approval. Half of his patients eventually pain warns us about an underlying injury Distortions in our mental sphere went into full remission and were still or illness. Emotions are processed by the commonly flow out of our minds and alive 20 years later, as reported in his limbic system, consisting of several into bodily functions. John Samo, MD, book, You Can Fight For Your Life.7 centers where nerve cells are connected Physiatrist, has successfully treated Bill Moyers' book and subsequent by nerve bundles to form a circuit. thousands of patients suffering from TV interviews have promoted the mind If an individual possesses a negative tension myositis syndrome orTMS. Most body connection which is predominantly emotion such asfearor unresolved anger, of his patients had low back pain which Eastern philosophy .8 His media exposure it will continue consciously or had not been alleviated by a variety of has bolstered the popularity of an subconsciously, for years if necessary, medical approaches. Dr. Samo believes approach that was previously considered until the conflict which created it is repressed emotions such as anxiety, fear "fringe". Pain clinics and psychiatrists resolved. To avoid being paralyzed with and anger cause the tension which leads are now using mind-body approaches to fear, a child's mind may unconsciously to muscle spasms and nerve pain. relieve chronic pain and suffering. repress a negative emotion, temporarily Other clinical research finds that the Many of our osteopathic colleges do or permanently stifling the memory. That two emotions invariably associated with not teach students how to incorporate negative emotion is still there, being illness are depression, which leads to the mind-body philosophy into their perpetuated in the limbic system. As an hopelessness and isolation; and chronic practice of medicine. This practical adult, this individual will continue to anger, which is stressful and alienating. psychology is desperately needed to experience more fear and anxiety than Dr. Bernie Siegel's cancerresearch found uncover many hidden problems. Any the average person, without even that the two emotions most often doctor, who deliberately and effectively knowing why. These negative emotions associated with physical health are the treats the mental factor in a patient's usually cause symptoms and disease capacity for love, which prompts feelings condition, will have an advantage over which may go unrecognized for a of security and intimacy; and hope or his less-well-equipped colleagues.9 lifetime. faith, which leads to a sense of meaning A DO's suspicion of subconscious A key part of the limbic system is the and resilience.6 These healthy emotions distress should be heightened when thalamus, an early processing station encourage more connectedness and patients are reluctant to have certain that receives input from the five senses awareness, while those that prompt non-painful manipulative procedures which it passes on to the cortex for separation and alienation are unhealthy. ➔
Winter 1995 AAO Journal/11 applied. Patients who do not respond to This capacity for abstract thinking, "uncertainty principle". Nuclear and manipulation for treatment of clinical coupled with the human spirit, also gives particle physics yield this new conviction problems such as temporomandibular us the ability to comprehend the unseen that there are scientific unpredictables. joint dysfunction, low back pain, neck spiritual realities of life. It has been said that, "Not only does God pain, headaches and irritable bowel Dr. Still stated, "The perfection of play dice with the universe, sometimes syndrome, are good candidates for Deity can be proven by His works. I He rolls them where you can't find them." psychological consultation. Pathological drew a line between debtor and creditor. The search for truth represents a longing, causes must always be ruled out first. On the one side, I placed the works of not a destination. The DO must work in a non-threatening, God. On the other, the acts of man who Hebrews 4: 12 suggests the extreme non-judgmental, patient-friendly office is the handiwork of God, the intelligent difficulty of distinguishing between the environment to identify patients with association of mind, matter and all spirit, soul and the spirit, alike in nature and repressed anger and fear. I have found the child of God, the author and builder their activities. Generally speaking, the that inner person communication can be of all worlds and all things therein." Dr. spirit is considered the higher, the soul, facilitated with han.ds-on patient contact. Still also stated, "God is the father of the lower element. The spirit may be In my experience, treating the head and osteopathy and I am not ashamed of the recognized as the life principle bestowed neck opens up new channels of thinking child of his mind."10 on man by God, the soul as the resulting and lowers patient barriers . The There is no doubt in my own mind life constituted in the individual, the osteopathic student needs to body being the material appreciate the power of the THE WHOLEPERSON: organism animated by soul and mind in the health and disease THEMIND spirit. of each patient. / ..... The human spirit is our Historically, when I- "spiritual sense organ". All religious fervor ran high, a: people everywhere have gods, ii: but in most cases they are false those suffering mental U) anguish found counsel and gods, invented by the human 7 ..... comfort by unburdening / mind when it rejects the truth MIND/SOUL zLU themselves to their priest. l l !: about the one God of the Today, many people have =z AUTONOMIC_ EMOTION- ' universe (Romans 1:18-32). NERVOUS l INlBilCT turned their backs on -L _r- However, when regenerated == SYSTEM WILL • organized religion, even 7 ...... by the Holy Spirit, the human ./ • z though they desperately need • er:: spirit has the ability to unbiased help. They suppress perceive, understand (to a ► cc== their suffering until a physical 0= w limited degree) and find m I- affliction drives them to seek fellowship with God. 0= medical advice. Although Conscience is our God physician and priest were one given, inborn faculty that tells and the same person in us right from wrong. It primitive society, this is no longer the that Dr. Still envisioned osteopathy to be prompts us to think wholesome thoughts, case. Many problems formerly handled more than just improving the practice of to speak and act morally and to recognize by priests now are problems requiring medicine of the day. For Dr. Still, the unwholesome thoughts and immoral medical attention, which leads us into patient was always more than the sum of behavior. Conscience can be shaped by the second part of the inner man - the his parts. As physicians, we expect parents and societal influences toward human spirit. science to answer the great questions on either of two extremes- permissiveness Approaching this second part of the the meaning oflife, although the answers and intolerance. In today's lax and amoral inner man requires a spiritual paradigm usually lie within ourselves. If we are society, it's not unusual for individuals within the practicing physician that can comfortable only with answers that can to have a seared and insensitive work with all patients. My spiritual be proven, we will never really be conscience in which right and wrong are paradigm is Christian. It does not prevent comfortable. Science is not something indiscernible. At the other extreme, in me from treating patients of other beliefs to worship. We worship to acknowledge cases of exceptional religious - including atheists. and revere the things we don't preoccupation, a person becomes To be made in God's image signifies understand. 11 obsessed with religious issues, such as a man's creative potential and ability to Interestingly, like the priests and continuing sense of guilt his actions or a comprehend complex and abstract ideas. visionaries, the physicists accept this continued on page 29
12/AAO Journal Winter 1995 Dr. DiGiovanna T. Letter to A. Still Named "NOF/AOA
Dear Doctor Still, Educator of the Year"
As we strive continuously to further our understanding of Eileen DiGiovanna, DO, FAAO, Professor and Chairof the the principles of osteopathic medicine, we wonder exactly Department of Osteopathic Manipulative Medicine at the what you thought about as you evaluated a patient. I think New York College of Osteopathic Medicine (NYCOM) has many DOs do not know about the information available from been named 1995 Educator of the Year by the National yourself and others on this topic. Osteopathic Foundation (NOF) and the American Osteopathic For instance, in his book The Lengthening Shadow of Association (AOA). Dr. DiGiovanna accepted the award Andrew Taylor Still, Hildreth described at least two ways (pp. during a ceremony at the AOA House of Delegates meeting, 181-184) in which you viewed the human body during your July 28 in Chicago, Illinois. examinations. He spoke about the way you viewed first the Dr. DiGiovanna was nominated by the dean of NYCOM, bony framework of the body, then the ligaments, muscles, Dr. Stanley Schiowitz, in recognition of her contributions to nervous system, arteries, veins, lymphatics and finally the osteopathic medicine and education, and to public health. The glandular system. He also related how you sometimes divided award is given annually to one outstanding educator in the spine into sections for diagnostic purposes. These sections osteopathic medicine who exemplifies and encourages the were the upper cervical, lower cervical, upper dorsal, mid principles of osteopathic medicine. She is the 13th recipient of dorsal, lower dorsal, the upper four lumbar vertebrae and the the NOF/AOA Educator of the Year Award. fifth lumbar and sacrum. "The causes of impaired health, In addition to her responsibilities as Department Professor sickness, pain and disability were directly related to mechanical and Chair, Dr. DiGiovanna is Associate Professor for Family alterations in the joint structures in these various sections of Practice at NYCOM and Assistant Dean for Student Affairs. the spine." She also directs NY COM' s Stress Management Program and In your own book, Philosophy of Osteopathy, you talked is the immediate past president of the American Academy of about yet another way you sometimes viewed the human Osteopathy. body. Here (pp. 28-29) you said: "I have formulated a simple During the 18 years of Dr. DiGiovanna's affiliation with mental diagram that divides the body into three parts, chest, NYCOM, she has written extensively, authoring several upper and lower limbs. The first division takes in the head, published articles and coauthoring the nationally recognized neck, chest, abdomen and pelvis. The second division takes in textbook, An Osteopathic Approach to Diagnosis and head, neck, lower and upper arm and hand. The third division Treatment. Dr. DiGiovanna is certified by the American takes in foot, leg, thigh, pelvis and lumbar vertebrae. I make College of Osteopathic Family Physicians, as well as the this division for the purpose of holding the explorer to the American Osteopathic Board of Special Proficiency in limits of all supplies. In the ellipse of the chest is found all vital Osteopathic Manipulative Medicine. She also maintains a supplies; then from that center of life we have two branches part-time practice, both in Family Medicine as well as only, one of the arm, and one of the lower limb. In each osteopathic manipulative medicine, at NY COM' son-campus division we have five points of exploration." health center. Dr. DiGiovanna is a graduate of Ohio State It seems clear that in keeping with the idea that each human University and the Chicago College of Osteopathic Medicine. being is unique, there is no one way to view all patients. Each She served her internship at the Doctor's Hospital in Columbus, must be approached as an individual, and this is what you did. Ohio. We all have to remember that in our quest for more and more Educators of the Year recipients are selected by one of the understanding of the principles of osteopathic medicine each nation's colleges of osteopathic medicine on a rotating basis, patient is unique. How we evaluate each patient must be in conjunction with the NOP Osteopathic Progress Fund & determined by the patient's particular circumstances, and not Seals Committee comprised of osteopathic physicians, by any preset formula. This is but one more item that makes osteopathic educators and AOA representatives. osteopathy something special. Since 1949, NOF has been instrumental in fostering a better understanding of osteopathic theory and practice. NOF Your ongoing student, provides loans and scholarships to osteopathic medical students Raymond J. Hruby, DO, FAAO and administers research grant programs for scientific and clinical osteopathic research. D Winter 1995 AAO Journal/13
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Thomas, Thomas, Dear Dear Structural and Hormonal Influences on Pelvic Mechanics in Labor and Delivery by Melicien Tettambel, DO, FAAO
Editor's Note: Melicien Tettambel, DO, tension, increased discharge of action uterus, cervix and upper vagina derive FAAO, is an active member of AAO. She potentials to initiate contractions, motor and sensory supply from S2,3,4. currently holds a position on the AAO augmentation of the velocity of The pudenda! nerve, from the anterior Board of Trustees; Education, Long contraction waves and enhanced rami of S2,3,4, innervates the perinea! Range Planning and Postdoctoral mechanical uterine activity. For instance, floor. Sympathetic and parasympathetic Standards and Evaluation Committees a uterus overstretched with twins incites uterine nerves are correlated with labor; hydramnios increases myometrial diffe rent myometrial layers: as well as AOBSPOMM. She is board 1 2 certified by the American Osteopathic tension, which facilitates contractions. • parasympathetic for the external Board of Obstetrics and Gynecology Myometrial contractility is also under longitudinal myometrial excitation; and in osteopathic manipulative neurohumoral control, and can be inhibition for inner circularly arranged medicine by AOBSPOMM. influenced by pharmacologic agents muscle. Sympathetic nerves excite the o xytocin, magnesium sulfate and circular musculature and inhibit the outer 3 4 anesthetics. This control, which may longitudinal muscles. Introduction initiate contraction waves, exerts its Mechanical stretching of the uterus Anatomy and physiology form the effect on a "myometrial pacemaker", and dilation of the cervix elicit neural basis for an analysis of the processes of usually located near the right uterotubal reflexes which travel through posterior labor and delivery. The osteopathic junction. Although physiologically routes of the spinal cord to the approach includes somatic dysfunction similar, this structure is not analogous to hypothalamus, causing release of both as a factor to be considered in the cardiac pacemaker regarding oxytocin; the reflex arcs return to the preparation of the patient, and as a result electrical activity, since the uterus does myometrium through motornerve fibers. of the complex interaction of structure not contain the same type of specialized Uterine and ovarian arteries are and physiological-chemical influences electrical conduction system as the heart. supplied with autonomic innervation that of pregnancy. Just as skeletal muscle inserts into enters the uterus with the vessels. aponeurosis, the myometrium ends at Therefore, uterine arteries are sensitive the cervix, which is comprised of to pressure and organ position. Both The Uterus connective tissue. In the pregnant state, adrenergic and cholinergic fibers The uterus is composed of a cervix, the cervix is composed of very loose surround uterine arteries. It is of note body and fundus. A developing fetus collagen and occasional elastin fibrils. that labor pain (from Tll-12) is often a occupies the body and fundus, a cavity In labor, cervical softening occurs in the consequence of uterine ischemia with made of smooth muscle layers: the endo absence of any direct mechanical or local cellular hypoxia. This is an excellent and myometr ium. Length-tension vascular connection to uterine activity. example of the nervous system as relationships of fibers depend on uterine On examination of a laboring patient, it mediator in labor and delivery. volume as the determining factor for the is possible to detect a dilated cervix During the developing pregnancy, the onset of spontaneous contractility. without an engaged presenting fetal part. increasing abdominal mass forces the Elasticity is not enhanced, as stretching The chief autonomic supply of the diaphragm superiorly, causing a is made possible by increased myometrial uterus is derived from the hypogastric reduction in respiratory excursions, and viscosity and plasticity. As the uterus plexus. Sympathetics from Tl0-11 increasing the work of breathing. Just expands near term, the following changes supply both body and fundus; the lower occur: development of myometrial AAO Journal/17 Winter 1995
1 1
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however, however, prior prior exert local effects within the uterus. Other conferences. She has outlined coccygeal posterior rotation of the rami with respect functions of relaxin include promotion dysfunction relative to obstetric to one another on a horizontal axis, as 6 of cervical dilation at term, and increased deliveries. However, some alternate well as superior/inferior positioning. coordination of uterine contractions points of view regarding the coccyx are Over time, if symphyseal lesions are not 5 during labor. offered. The position of this bone may addressed, urinary problems may rise, be altered by trauma to the perineum, but as the urethra lies just below the Structural Features it may also be altered in response to symphysis. The bladder fascial attachments also adhere to the rami. As 1 the Maternal Pelvis changes in the sacral curve resulting of from trauma before, during, or after the pregnant uterus enlarges, bladder Boney components of the maternal l conception. function may often be compromised. pelvis, the four basic types of pelvic Local trauma to a "young" pelvis, Uncorrected pubic lesions with torsion architecture, and osteopathic insights which is formed in multiple parts, and of pelvic fascias will continue to affect regarding birth and related injuries will therefore, is quite malleable, may prevent bladder performance after delivery an1 be addressed. the coccyx from firmly attaching to the even long after childbearing has ceased. sacrum, resulting in ligamentous Sacrum connections which do not stabilize the At birth, infants of both sexes have an "tail" of the sacrum. As previously The Four Major Pelvic Types S 1 body that is twice as broad as the alae. mentioned, the sacrum does not usually Except for the gynecoid pelvis, The female sacrum and pelvis become "unite" before the age of 30. During females may also exhibit combinations broader during puberty, resulting in a puberty, "growth centers" in the sacrum of pelvic architecture through the greater width of the pelvic inlet. By the are exposed to stresses that may induce combined influences of genetics, growth, eighteenth year, the two lowest segments a local (sacral) scoliosis in the pelvic trauma, and nutrition. The types are become united by bone; the union extends structures, with the coccyx responding briefly described below to refresh clinical upward to sacral base by age 30. For to sacral influence upon future honey as considerations of pelvic examinations structural reasons, it is important to have well as ligamentous growth and in assessing cephalopel vie dysproportion symmetric growth during childhood an_d development. If childbearing occurs after or possible structural reasons for adolescence. Since the sacrum and pelvis puberty but before age 30', sacro prolonged labors. are quite malleable, trauma and coccygeal architecture is subject to the nutritional status are important dictates of nutrition, altered posture due Anthropoid considerations in assessing the pelvis to increased weight-bearing of The anthropoid pelvis is the generic for reproductive function. Calcium and pregnancy, and somatic dysfunction "humall' prototype" pelvis with narrow vitamin Dare needed early in life, before incurred on the delivery table, if the conception, and certainly before sub-pubic arch and straight sidewalls. patient struggles in improperly-placed The transverse diameter is located well menopause. stirrups, while lying in the lithotomy in advance the sacral promontory. A The sacrum continues downward and of position. large sacrosciatic notch is present. Labor ends well below the pelvic inlet. The in the anthropoid pelvis follows the coccygeal end may be subject to trauma Pubic Symphysis normal mechanism, although the fetal during delivery, if not before, prior to The pubic symphysis connects the vertex may engage the pelvis in an total sacral segmental union. This should two weight-bearing arches of the occiput posterior position and remain in be taken into consideration by the innominates, which transfer the weight that position without rotating anteriorly. obstetrician who may note serial episodes of the trunk from the sacrum to the hips. of trauma with multiple deliveries in a The superior and inferior ligaments are Gynecoid woman before age 30. Conversely, in not simply bridges to connect the rami, This "classical" female pelvis is the primigravid woman above age 30, but also have some oblique fibers. The identifiable by a rounded pelvic inlet the sacrum may not be as "plastic" during I inferior pubic ligament provides most of composed of a curved subpubic arch and laborer delivery. If forceps are necessary, \ the symphyseal joint stability; the rounded apex with ample space between 'I the line and angle of the sacrum must be superior and circumferential ligaments the ischial tuberosities. The sacrum appreciated. maintain mechanical integrity, usually slopes backward, causing divergence of allowing about 3mm of motion; up to 10 the pelvic basin. The patient with such a Coccyx mm of motion can be noted during pelvis may enjoy a shorter labor, as this Edna M. Lay, DO, FAAO has pregnancy. Obliquity of the fibers of the architecture provides ample space for presented an osteopathic overview of pubic ligaments allows for anterior/ the fetus to negotiate its path. the coccyx at Cranial Academy --+ AAO JournaV19 Winter 1995 Android The anterior portion of the lower the fetus through the pelvic outlet may This "m asculine" pelvis has a uterine segment is firmly fixed by fascial be confined by a pubic arch that permits subpubic arch with a narrow angle and and ligamentous attachments. This fact only the posterior component of the straight line. The ischial spines are may account for the cervix moving perineum to distend and allow deli very. prominent. Pelvic sidewalls are anteriorly from its location in the Fortunately, the human pelvis is shallow, convergent, with a wedge-shaped inlet. posterior fomix, as observed in early with a generous aperture of the pelvic The transverse diameter is situated close labor, with cervical effacement and inlet. to a sacrum that is forward-bent towards dilation. In early labor, the uterus moves the ischial spines. A small sacro-sciatic forward in the abdomen until its long notch is noted; this may provide a axis comes to point directly downward Somatic Dysfunction I challenge to those who attempt local/ at right angles to the superior strait of the as a Result of Pregnancy, regional anesthesia for a patient with pelvis. The fetal body loses its posterior such a pelvis via pudenda! block! Labor curvature and its vertebral column tends Labor and Delivery in the android type of pelvis starts with to straighten, depending on the amount Pregnancy may be an etiologic factor the unengaged vertex entering the inlet of amniotic fluid present. This forward in the development of prolapsed lumbar through the oblique diameters of the movement enables the force produced disks in some women. Sciatica pelvis. Rotation occurs very low in the by the uterus to be transmitted to the sometimes can be attributed to prolapse pelvis, unless the sacral promontory cervix for impending effacement and which occurred during or immediately prohibits this maneuver; in such a case, dilation. after pregnancy. There can even be lower operative delivery may be necessary. The fetal vertex descends into the limb paresis of a severe degree, involving pelvis in an attitude of flexion along the the ankle, hip or knee. During a postural Platypelloid sacrum until it meets honey resistance at evaluation, short leg syndromes and any A wide subpubic arch with straight the sacrococcygeal platform. Then it history of low back injuries and/or and/or divergent sidewalls and a wide continues downward inflexion until the problems should be identified and interspinous diameter are the major biparietal diameter reaches the trans verse assessed prior to pregnancy, if possible. characteristics of this type of pelvis. diameter of the pelvic outlet, which During the course of a pregnancy, There is a short anteroposterior and a means that the occiput is about to pass by postural changes and anteroposterior wide transverse diameter. The sacrum the inferior border of the pubic curves of pregnancy should be regularly has a "normal" curve; the sacro-sciatic symphysis. Next, the vertex extends by evaluated and treated. notch is large. Provided the pelvic inlet resistance (probably not by fetal choice!) Nerve plexus lesions can cause admits the fetal head, labor and delivery of the pubococcygeal muscles and the weakness and sensory symptoms in either are usually unrestricted. However, in a transverse perinea! muscles. If extension polyradicular or peripheral nerve woman with a large platypelloid pelvis, occurs, the larger occipital-frontal distribution in the legs. Because only the vertex may persist in the transverse diameter must pass through the inferior anterior primary rami contribute to the position until it reaches the pelvic floor, pelvic plane, rather than the smaller plexus, proximal radiculopathy can be 8 resulting in an arrest of labor. suboccipitalbregmatic diameter, which distinguished from a plexus lesion by passes through this plane when the head electromyographic (EMG) examination is well-flexed. Extension that occurs of muscles supplied by posterior primary Structural Mechanics during the course of "normal" labor is at rami (paraspinal muscles), involvement the expense of distention and disruption of which favors a root lesion. of Labor of structures within the perineum and Roots of the sciatic nerve may be After the thirty-fifth week of gestation, endopelvic fascia beneath, and compressed in the pelvis by the fetal uterine activity may be observed to occur supporting the bladder. To prevent major head, or by forceps; the motor deficit is in an irregularly-regular pattern. As labor disruption, episiotomy is performed to borne by muscles which are supplied by ensues, disorganized contractile activity allow the rectum to fall away from the the common peroneal fibers . A common becomes synchronized and predictable. flexed fetal head. It may also be example is the short patient with a small The process is also assisted in the performed to prevent bladder prolapse pelvis, carrying a large fetus, who primigravida with well-toned abdominal in a woman who has been pushing for an requires forceps assistance for deli very. musculature, which can be used to push extended period of time. Such a patient usually has a straight the lower pole of the fetus into the pelvis. Prominent ischial spines may interfere sacrum, a flat, wide posterior pelvis with Not all multigravidas can count on these with passage of the fetus through the wide sacro-ischial notches. Especially abdominal muscles to perform consistently midpelvis and outlet planes. Delivery of in this sort of patient, complaints of leg with successive pregnancies, however. weakness on ambulation should not be
20/AAO Journal Winter 1995 confused with ep1S1otomy pain. The the lower leg. If a patient is placed on the of normal labor and delivery is most patient should be examined for foot drop, delivery table in an extreme lithotomy beneficial to the Osteopathic physician numbness over the dorsum of the foot, position, she may experience weakness who not only addresses somatic and the lateral leg, as well. of the quadratus muscles, along with dysfunction resulting from spontaneous Sciatica may also result from sensory impairment over the (as well as complicated) deliveries, inadequate knee and hip flexion when anteromedial aspect of the thigh, and whether this dysfunction manifests the patient is placed in the lithotomy occasionally have sensory impairment immediately in the delivery room, or position, as commonly occurs before of the leg to the medial malleolus, along after a longer time period; but also the and during delivery. Extreme external with decreased knee jerk. osteopathic physician can provide an rotation of the hip may result in weak In order to make obstetrical deliveries opportunity for optimal obstetrical care dorsiflexion of the foot, with eversion. in the hospital more "homelike", the through identification and elimination Meralgia paresthetica results from a traditional delivery table has been of preexisting or acquired somatic stretch on L2-3 in the third trimester of designated for more technically difficult dysfunction. A.T. Still aspired toward pregnancy; obesity may aggravate this deliveries. Birthing beds have become excellent care during pregnancy so that condition. The lateral femoral cutaneous quite popular, allowing the parturient to "Nature's team never fails to deliver all nerve runs under the outer portion of the have more freedom in positioning her goods entrusted to its care''. inguinal ligament to reach the thigh. body and extremities while giving birth. Sometimes the ligament splits to enclose After ambulating about the room or References the nerve. In this latter situation, hallways, she may return to her bed for 1. Caldwell, W. E., Moloy, H. C. Evaluation of hyperextension of the hip or increased delivery, which may be arranged with the pelvis in obstetrics. Am. J. Obstet. Gynecol., lumbar lordosis will lead to compression cushions or positioned in a chair-like 40:558, 1940. of the nerve by the posterior fascicle of manner in order to assist gravity while 2. Creasy, R. K., Resnick, R., eds. MATERNAL the ligament. she is pushing. The patient may also lie FETAL MEDICINE: PRINCIPLES AND The obturator nerve originates within on her left side (to take pressure off the PRACTICE. W. B. Saunders Co., Philadelphia, PA., 1984. the psoas muscle from L2,3,4, emerges great vessels) while pushing. This from the medial border of the psoas, and position also removes weight from the 3. Huszar, G. THE PHYSIOLOGY AND enters the pelvis immediately in front of sacrum and allows the bi-parietal BIOCHEMISTRY OF THE UTERUS IN PREGNANCY AND LABOR. CRC Press, Boca the sacroiliac joint. It sweeps around the diameter of the fetal head to rotate into Raton, FL., 1986. lateral pelvic wall and then passes the path of least resistance within the through the obturator foramen, dividing maternal pelvic soft tissues. 4. Romanes, G.J. CUNNINGHAM'S MANUAL OF PRACTICAL ANATOMY, Volume II: into branches that supply the adductor, Positioning the patient who is pushing Thorax and Abdomen. Oxford University Press, gracilis and obturator externus muscles, into a prone knee-chest manner on the New York, 1972. as well as the skin over part of the medial bed to deliver a posterior occiput fetus 5. Challis,J.R.G., Lye, S.J. Parturition. Oxford thigh and hip joint. This nerve may be spontaneously, may eliminate the need ReviewofReproductiveBiology, 8:6L-129, 1986. injured during placement of the patient for forceps rotation oroperative delivery. 6. Lay, E. The Coccyx. Oral presentation at in the lithotomy position on the delivery The abdominal musculature, placed in a Cranial Conference in Kansas City, Mo., 1979. table, or by compression between the dependent situation, relieves the 7. Gamble, J.G., Simmons S.C., Freedman, M. fetal head and boney pelvic wall. Such impacted head in the pelvis and guides The symphysis pubis: anatomic and pathologic an injury leads to impaired gait, because the fetal body without exerting extra considerations. Clinical Orthopedics, 203:261 - of weak adductor muscles and sensory force on the emerging head. 273 (Feb.), 1986. disturbance involving the medial part of 8. Assali N.S., Brinkma n C .R., eds. the mid- and lower thigh. Pain may also Conclusion PATHOPHYSIOLOGY OF GESTATION. Volume l: Maternal Disorders. Academic Press, radiate from the groin down the inner Those who care for the female patient ,, New York, 1972, pp. 146-267. side of the thigh. during herreproductive years must become The femoral nerve (within the psoas, well acquainted with the female pelvic 9. O'Connell, J.E.A. Maternal obstetrical paralysis. Surg. Gynecol. Ohstet., 79:374, 1944. L2,3,4) passes beneath the inguinal architecture and postural mechanics. Prior ligament to enter the thigh. It innervates to conception, baseline structural and 10. O'Connell, J.E.A. Lumbar disc protrusions in pregnancy. J. Neurol. Neurosurg. Psychiatry~ the iliacus, sartorius, pectineus and hormonal information assists the clinician 23:138, 1960. quadratus femoris muscles. Its cutaneous in assessing and possibly predicting branches supply the anterior and medial mechanical factors which may inhibit and 11. Still, A.T. THE PHILOSOPHY AND MECHANICAL PRINCIPLES OF portions of thigh and, through the even prevent a spontaneous vaginal saphenous nerve, the medial portions of OSTEOPATHY. Hudson-Kimberly Publishing delivery. Knowledge about the process Co., Kansas City, Mo. p.311, 1902.D
Winter 1995 AAO Journal/21 1996 Convocation Progratn March 27-30, 1996 "Persistent Somatic Dysfunction: Causes and Treatment Strategies" G. Bradley Klock, DO, Program Chairperson
Tuesday, March 26, 1996 Workshops: 9:00am- 5:00pm AAO Board of Governor's Meeting (this workshop runs one-hour and is repeated (3) times today) 7:00pm- 9:00pm Opening Reception 2:00 pm- 3:00 pm A1- Proprioceptive Retraining Workshop Dr. Vladimir Janda 3:00 pm- 4:00 pm A2- Proprioceptive Retraining Workshop Dr. Vladimir Janda Wednesday, March 27, 1996 4:00 pm- 5:00 pm A3- Proprioceptive Retraining Workshop 7:45 am- 8:00 am Welcome-B radley Klock, DO, Program Dr. Vladimir Janda Chair and Boyd R. Buser, DO, AAO President (this workshop runs one-hour and is repeated (3) times today) 8:00 am- 9:00 am Somatic Dysfunction Generated 1 2:00 pm- 3:00 pm B - Visceral Manipulation by Joint Surface Irritation Kenneth J. Lossing, DO Frank Willard, PhD 2 3:00 pm- 4:00 pm B - Visceral Manipulation 9:00 am- I 0:00 am Proprioceptive Input and its Relationship Kenneth J. Lossing, DO to Generating and Treating Somatic 3 4:00 pm- 5:00 pm B - Visceral Manipulation Dysfunction Kenneth J. Lossing, DO Dr. Vladimir Janda 10:00 am-10:30 am Refreshment Break with the Exhibitors (this workshop runs three-hours today and is repeated tomorrow) 10:30 am-11:30 am Somatic Dysfunction Generated by 1 2:00 pm- 5:00 pm C - Triggerpoint Injection Workshop Visceral Problems: The Feedback Loop Andrew A. Fischer, MD, PhD Frank Willard, PhD 11:30 am-12:30 pm Visceral Manipulation: Theory, Practice and its Effect on Structural Patterns Kenneth J. Lossing, DO Thursday, March 28, 1996 12:30 pm- 2:00 pm Lunch 8:00 am- 9:00 am Somatic Dysfunction Generated by Muscle and Nerve Root Irritation Frank Willard, PhD
22/AAO Journal Winter 1995 9:00 am-10:00 am The Diagnostic and Therapeutic Roles Workshops of Trigger Point Injections (these workshops run for three-hours each) Andrew A. Fischer, MD, PhD 2:00 pm- 5:00 pm D- Body Stabilization Workshop 10:00 am-10:30 am Refreshment Break with Exhibitors Terry Roach 10:30 am-11:30 am Diagnostic and Therapeutic Injections Timothy King, MD E- "Train the Trainers" Workshop 11 :30 am-12:30 pm Psychiatric Evaluation and Treatment Nancy Edwards, Director of Patients with Persistent Somatic AOA Payor Relations Dysfunction Richard Rosengard, DO . I 12:30 pm- 2:00 pm Lunch Saturday, March 30, 1996 8:00 am- 9:00 am Muscle Energy: Advantages, Shortcom I Workshops: ings and How to Integrate the Technique (this workshop runs one-hour and is repeated (3) times today) Gary Ostrow, DO 4 2:00 pm- 3:00 pm A - Proprioceptive Retraining Workshop 9:00 am-10:00 am Counterstrain: Advantages, Shortcomings Dr. Vladimir Janda and How to Integrate the Technique 3:00 pm- 4:00 pm A5- Proprioceptive Retraining Workshop John Glover, DO Dr. Vladimir Janda 10:00 am-10:30 am Refreshment Break 4:00 pm- 5:00 pm A6- Proprioceptive Retraining Workshop 10:30 am-11:30 am HVLA: Advantages, Shortcomings and Dr. Vladimir Janda How to Integrate the Technique John Hohner, DO (this workshop runs one-hour and is repeated (3) times today) 11:30 am-12:30 pm New Ideas Forum 4 2:00 pm- 3:00 pm B - Visceral Manipulation 12:30 pm- 2:00 pm Lunch Kenneth J. Lossing, DO 2:00 pm- 5:00 pm Conclave of Fellows; The "New" Fellow 5 3:00 pm- 4:00 pm B - Visceral Manipulation Anthony Chila, DO, FAAO, Kenneth J. Lossing, DO Program Chairperson 6 4:00 pm- 5:00 pm B - Visceral Manipulation Kenneth J. Lossing, DO
(this workshop runs three-hours today) The Stouffer Renaissance Waverly Hotel 2 2:00 pm- 5:00 pm C - Triggerpoint Injection Workshop Atlanta, Georgia Andrew A. Fischer, MD, PhD
(this workshop is limited to FAAOs and Undergraduate Fellows) CME Credits 3:30 pm- 5:00 pm Fellows Forum Harold I. Magoun, DO 28 Hours Main Program &. Conclave 3 Hours CME - Exhibit Visitation
Friday, March 29, 1996 For more information, Contact: 8:00 am- 9:00 am Rheumatologic Evaluation and Treatment of Patients with Persistent Somatic Dysfunction Joy Schechtman, DO A.American 9:00 am-10:00 am Diagnostic Radiology: What Tests are Reasonable and Why Academy of David Berg, DO Osteopathy 10:00 am-10:30 am Refreshment Break 10:30 am-11 :30 am Physiatrist's Approach to Persistent Somatic Dysfunction 3500 DePauw Boulevard, Suite 1080 James A. Lipton, DO, FAAO, Indianapolis, IN 46268-1136 LCDR, MC, USN Phone: (317) 879-1881 11: 30 am-12: 30 pm The Potential for Outcomes Research FAX: (317) 879-0563 inOMM Michael Kuchera, DO, FAAO 12:30 pm- 2:00 pm Lunch
Winter 1995 AAO Journal/23 From the Archives Mother Still
Hundreds and even thousands of was a co-worker in all his trials and "To those whom she has left behind, osteopathic physicians revered and loved tribulations in the mighty battle he fought the hearts of our whole profession go out to call Mrs. A. T. Still, the wife of the for osteopathy. All the way from those in great sympathy. Long will her memory founder of osteopathy, "Mother Still". troublous times in Kansas on down be kept green in our hearts.-Charles She was representative of all that was through their change of residence to Hazzard, DO" best in womanhood. Kirksville, stood ever in the thickest of "After an illness running over several Surely God in his wisdom in choosing the battle and unwaveringly encouraged years, death finally claimed Mother Still Dr. A. T. Still as His instrument to do a her husband in all his undertakings. at her home in Kirksville, May 29. Senile great work for humanity, was not Under all conditions she as the same nephritis had done its work. Skill and unmindful of the necessity of providing staunch, heroic character, bearing in her faithfulness did what might be done, him with a mate capable of carrying her quiet, humble way her portion of her worn the body away. For fifty years she share of his burdens, to stand close by husband' s burdens. had stood by her husband's side. The him in his trails and struggles. She was To Mother Still should be given a big burial was made at Kirksville, May 30. well qualified by education, a woman share of the credit for the great work. Dr. H.L. Chiles, DO" capable of being "Mother" to his children, Still accomplished in giving osteopathy "Probably comparatively few knew of the quiet sustaining force of Mother a woman with ability little dreamed of to the world. God ever bless her name! Still; how each member of the family by the average person with whom she The following editorials appeared in depended on her, and gladly listened to came in contact, a woman whose heart The Journal of the American Osteopathic her counsel. She had a background of was just as brave and strong as her Association for June, 1910, at the time of osteopathic experiences that was husband' s with a confidence in "her Mother Still' s death: "To all of us who invaluable, which, with her sound man", a loyalty in her soul that gave her knew Mother Still comes the sense of a judgement, commanded great respect. strength to share with him in all his great personal loss at her passing away. Her patience and fortitude and faith all When we go back to Kirksville some undertakings, and fight the battles oflife through the early days of osteopathy day and look down the familiar streets side by side with him. contributed no little to osteopathic and at the big house on the hill, the old It was in the beginning days, out in development. town will not seem quite the same to us, Kansas, that an incident occurred which, "I met her when I first went to without doubt, contributed in a most because she is gone. Kirksville, and frequently saw her wonderful way to Dr. Still's success in "Her quiet, kindly ways; her always afterwards. The students were eager to life. His wife wrote to her father, an ready smile; her simple motherly aspect; consult with her for she was deeply allopathic physician practicing in New the quiet devotion of her daily life; her interested in their work. She had a certain York state, of the remarkable results her unostentatious charities; all these and detachment in viewing their problems, husband was obtaining. The father came many more lovable qualities endeared no doubt the result of years of familiarity to Kansas to investigate. After spending her to us. with osteopathy, its growth, struggles some time with his daughter and her "She beheld our great science in its and requirements, that particularly family and listening to Dr. Still's swaddling bands; saw it tended and appealed to everyone. reasoning, he told his daughter that he nurtured through the lean and hungry "No outsider can really know what could not understand "Drew's" years; endured privation, and, no doubt, sacrifice she made in order to assist in (Andrew's) philosophy, but felt that he often dire need, for its sake; stood faithful the up-building of osteopathy. Her heart had something that hi'S own school did and undaunted by her husband's side and soul were in her family, and in the not have and advised her to stand by him through all the fierce turmoil of his life's best interests of all. Her indomitable and in his undertaking. There is no doubt but great battle; gave counsel and cheer, and sympathetic spirit, one of real that her father's advice, coupled with strength, and comfort to him in the strife. understanding, was a distinct factor in her love for her husband and her "We thank God that she came through the developing and organizing of confidence in him, gave her strength, it all, sweet and happy, into a green and osteopathy. - Carl P. McConnell, DO" fortitude, courage and force of character peaceful old age. A wife, a helpmate, a that enabled her to stand unfailingly mother-she was all these in their truest Reference Book - The LengtheninfgJ with her husband in his great work. She and fullest sense. Shadow of Dr. A. T. Still, P. 284-286. 24/AAO Journal Winter 1995 From the AOBSPOMM Files
AAO Case Study: Trigeminal Neuralgia by David Coffey, DO, CSPOMM
Editor's Note: David Coffey, DO is a begins in the area of the left zygoma and Social History: 1984 graduate of the Philadelphia radiates to the left upper teeth and left The patient is widowed with two College of Osteopathic Medicine. Vice jaw. Pain is not relieved by ibuprofen or children and lives alone in a home close President of The Cranial Academy, he by increasing the carbamazepine dosage. to her married son and two grandchildren. has been a member of both the American The patient had less severe episodes in She has had a supervisory position in a Academy of Osteopathy and the the past which responded osteopathically prestigious local store for over thirty American Osteopathic Association for to myofascial release of the cervical and years. She is first generation Italian, has 10 years. Dr. Coffey is certified by the suboccipital areas. However, this time never smoked and drinks wine and beer American Osteopathic Board of Special there was no relief with osteopathic in moderation, and, is noted for her Proficiency in Osteopathic Manipulative treatment directed to the suboccipital, homemade ravioli. MedicineaswellastheAmericanCollege cranio-cervical, or cervical somatic of Osteopathic Family Physicians. He dysfunction. Physical Examination: has a private practice in Montgomery, Vital Signs: BP = 100/60; HR = 76; Alabama. Past Medical History RR= 20; T = 97 .2 F. HEENT: PERLA, Significant for rubella, varicella, EOMI, No nystagmus. No visual field Identification: sinusitis, otitis media, upper respiratory deficits. No diplopia. Cranial Nerves II Josephine M. is a white, 68-year-old, infections, pneumonia, C . dificile through XII intact. External canals patent. female supervisor at a local department enteritis, UTI, urethral stenosis and Tympanic membranes intact and without store. degenerative arthritis of the lumbar and injection. Septum midline. No intraoral cervical spine. mucocutaneous lesions. Partial dentures Chief Complaint: upper and lower. Onset of Trigeminal Severe left facial pain over a two-day Past Surgical History Neuralgia following extraction of left period. Significant for cholecystectomy, upper second premolar. No thyro hysterectomy, Marshall-Marchetti megally. No lymphadenopathy. There is History of Present Illness: Bladder repair. an increase of the cervical lordotic curve The patient developed severe pain in with disc space narrowing. There is a the area of the left zygoma upon Allergies: Codeine general pattern of left sidebending awakening from sleep two days prior to rotation of the cervical spine from C2 to presenting to her family physician. The Medications: C7 with the left occiput being posterior and inferior. The left temporal and left patient has a past medical history of Carbamazepine 100 mg., PO, TIO. zygoma were externally rotated; the left trigeminal neuralgia which had been ibuprofen 200 mg., PO, PRN pain. controlled with subtherapeutic doses of sphenoid was superior, and the left orbit was widened. On the left side the upward carbamazepine , moist heat and Family History: ibuprofen. The patient was under the convexity of the palate was widened and The patient's brother died of an MI. added stress of preparing for the onrush the pterygoid was superior and lateral; Father with CAD. Mother healthy. of Christmas shopping. Pain is spasmodic there was compression of both the and incapacitating; moreover, it has sphenoparietal and sphenosquamous become increasingly unremittent. Pain sutures. Physiologically, there existed an --+ Winter 1995 AAO Journal/25 overall left torsion disturbance of cranial Impression: patient was instructed to call if the pain mechanics. 1. Trigerninal Neuralgia on the left. returned and to take the medications as 2. Intractible pain. prescribed for the next two days. On return THORAX: Heart sounds regular with 3. Left torsion cranial somatic visit in two days there was no left torsion occasional ectopic beats. Grade II dysfunction. pattern and the symptoms had not returned. holosystolic murmer heard best at the 4. Cervical, thoracic, lumbar, sacral The patient was instructed to resume her Apex. Lung sounds clear bilaterally. and pelvic somatic dysfunction. previous medications and reduce the Breasts with fibrocys tic disease Carbamazepine to 300 mg./ day. bilaterally . No costal tenderness. Treatment Plan Increased thoracic kyphosis with chronic 1. Osteopathic treatment of the cranial DISCUSSION: This case demonstrates Fryette Type I somatic dysfunction at T4 left torsion somatic dysfunction. the cause and effect relationship between -T8 arid TIO - Tl2. No scoliosis. 2. Increase the carbamazepine to 500 dental extraction, facial pain and cranial mg./ day in three somatic dysfunction. The patient's severe ABDOMEN: There is a right subcostal doses(200, 100,200) facial pain follows the sensory pathway cicatrix and a rnidline cicatrix from the tid. of the Maxillary di vision of the umbilicus to the pubes. Active bowel 3. Naproxen 500 mg., PO, bid; Trigerninal Nerve which consists of first sounds x 4. No tenderness; no Propoxyphene N-100, PO, q 6H, order neurons that synapse in the organomegally; no masses. PRN pain. Semilunar ganglion and descend 4. Osteopathic treatment to the remain ipsilaterally as the spinal tract ofV to the PEL VIS: Patient with recent ing areas of somatic dysfunction. third or fourth cervical segment where gynocological evaluation and rectal they merge with the dorsolateral fasiculus examination which were negative. There Course of Treatment of the cord and synapse in the ventral was no complaint of urgency, frequency posteromedial nucleus of the thalamus. Following an indepth osteopathic or dysuria and no inguinal adenopathy. As it courses from the pterygopalatine evaluation, the course of treatment There were bounding femoral pulses fossa to the orbit, the second division of focused on correcting the left torsion bilaterally. LS was rotated left with left CN V passes between the maxillary pattern with emphasis on disengaging sidebending. The sacrum was posterior tuberosity and the greater wing of the the left sphenoparietal compression first and inferior on the left. There was a mild sphenoid and through the inferior orbital and then attacking the sphenosquamous posterior rotation of the left inanimate. fissure. A torsion cranial somatic compression. dysfunction effects the Falx Cerebri by This was accomplished using a vault EXTREMITIES: The radial, popliteal leaning away from the superior greater hold and an indirect technique on the left and dorsalis pedis pulses were intact wing and can inhibit venous drainage, sphenoparietal suture followed by bilaterally. There was mild tenderness prolonging the inflammatory process and decompression of the sphenosquamous of the shoulder, elbow, knee, wrist and resultant pain. A sphenosquamous suture by means an intraoral ankle joints at the end points of of compression can also effect lymphatic disengagement of the lateral pterygoid. physiologic range of motion consistent and venous return and increase the pain The patient's response was marked with with aging. There was a decrease range process. The patient's dramatic relief of instantaneous relief of her pain much to of motion in hip flexion, extension, symptoms can best be explained by the amazement of the physician. The internal rotation and external rotation removal of pressure on the Maxillary n. sacral left torsion pattern resolved with bilaterally. and the promotion of venous and the cranial treatment. The treatment was lymphatic drainage. The sacral somatic concluded with myofascial release to NEUROLOGIC: There were no focal dysfunction directly resulted from the neurologic deficits. No clonus; no the craniocervical junction and to the left torsion and corrected with it; the cervical, thoracic, lumbar, pelvic, and Babinski. Mental status was intact; remaining somatic dysfunction was sacral somatic dysfunction, and with a however, the patient was in severe chronic and compensatory in nature and compression of the fourth ventricle to distress secondary to incapacitating pain. secondary in importance to the primary facilitate cerebral spinal fluid flow. The left torsion. D Are the Academy's Records Correct? Be sure to let us know if you have a new name, home or office address, FAX or telephone number! The American Academy of Osteopathy; 3500 DePauw Blvd., Suite 1080; Indianapolis, IN 46268-1136; Phone: (317) 879-1881; FAX: (317) 879-0563
26/AAO Journal Winter 1995 tiam ofi the Euslachian Tube
by J . Scott Heatherington, DO
hile browsing through the on the left if treating the left tube. is in infants and children with recurrent 1962 AAO Yearbook Stabilize the head with the non otitis media. In this condition, as in others, W recently, I reread an article treating hand on the forehead, have the evaluating the cranium and the cervical by T.J. Ruddy, D.O. in which he talked patient open their mouth and pantthrough spine is also very important. Frequently, about manipulating the eustachian tube the mouth, insert the index finger into there will be dysfunction of the temporal and middle ear. The technique is one I the mouth to a point near the low end of bone and/or C3-4 on the involved side. have used for nearly 50 years, since the posterior pillar of the right tonsil, having learned it from W.W. Howard, from this point it is usually easier to get Case History #1 the finger posterior to the soft palate. D.O.inMedford, Oregon, who had taken A nine month old male infant was Move the finger tip cephalad and slightly his specialty training under Dr. Ruddy. brought to the office by his parents. lateral to the fossa of Rosenmuller The approach to manipulating the They related that he had begun crying posterior to the opening of the eustachian eustachian tube is through the mouth to and screaming and pulling at his left ear tube into the pharynx. In adults, one may the nasal pharynx. It is not a comfortable about 3 :00 a.m. on that day. They denied encounter adhesions in the area of the procedure for the patient, however, it is any previous history of similar behavior. fossa, usually they can be lysed easily not painful. It may cause very temporary Examination was somewhat difficult with the finger tip, place the pad of the gagging or retching. The manipulation because the patient did not wish to be finger over the fossa opening and use an only requires 10-20 seconds to complete, touched. The throat was not inflammed. intermittent pressure, a pumping motion. and in acute conditions, usually does not The right ear canal and tympanic This will tend to open the tube, allowing require repeat manipulation. membrane were normal in appearance. an equalizing of atmospheric pressure Indications for the procedure include The left ear canal was normal, but the on both sides of the tympanic membrane. acute otitis media (simple, suppurative, tympanic mem brane was mildly This also allows relief of the vacuum in and recurring), impaired hearing due to inflammed with moderate bulging. He the middle ear which improves drainage otitis media with effusion ( except in had a temperature of 101 ° and the parents of any mucous or liquid from the middle nerve deafness), chronic otitis media, related that he had refused solid foods, ear. turgescence (plugged ear), secondary to but would take liquids. There was no In cases of acute otitis media, the an upper respiratory infection or altitude evidence of adenopathy in the cervical earlier the treatment can be administered, change. It is also beneficial immediately area. the more complete the relief and the less following adenoidectomy to prevent Our tentative diagnosis was of acute likely treatment will need to be repeated. turgescence. otitis media of the left ear. In patients with chronic otitis and/or In prep arin g a patient for the Treatment was finger manipulation hearing loss, the treatment may need to procedure, they should be told what to of the left eustachian tube. The procedure be repeated several times. Treatment expect in the way of discomfort and was done with the parent' s assistance in will not benefit those with nerve deafness gagging. Advise that they breathe by restraining the child. Alternate pressure or where there is lessened movement panting through their mouth to reduce and release over the eustachian opening (fixation) in the ossicular chain. tile gag reflex. The tendency is to breathe in the fossa Rosenmull er wa s In my experience, I have found that through the nose. Also, have them hold accomplished. there is usually a tenderpoint about one their own hands and to not grab yours. In Following treatment, the child quieted inch anterior to the angle of the mandible children or infants, it helps to have the immediately, and by the time I had on the involved side, medial to the ramus. parent or an assistant hold their hands. finished instructing the parents about When this tenderpoint is present, my The treatment can be done with the aftercare, the child was asleep. No further results are usually better and the patient seated or supine, I prefer the treatment was required in this case. latter because the head is more stable. A tenderpoint is usually gone following ➔ gloved or cotted finger on the right hand, treatment. if treating the right eustachian tube, and Another indication for this treatment
Winter 1995 AAO Joumal/27 Case History #2 A 56-year-old afebrile as long as he was taking His mother reported in January 1995, that there had been no recurrence of female who was being treated for antibiotics. fever or ear drainage. unrelated complaints, mentioned that her X-rays of sinuses were taken in April, hearing had been bad since she t~aveled 1994, with diagnosis of sinusitis. by air a few months earlier and her ears Antibiotics were continued for two Summary months following which the fever and felt plugged. Examination revealed no Manipulation of the eustachian tube evidence of inflammation in the ears, purulent drainage from the ears recurred. is indicated in acute otitis media, nose, or throat. Palpatory examination Referral was made to the Osteopathic recurrent otitis media, impaired hearing revealed some somatic dysfunction at Manipulative Medicine Department at secondary to otitis media with effusion, C4-s. A tenderpoint medial to the ramus Eastmoreland Hospital, where he was chronic otitis media , turgescence of the mandible about one inch anterior treated with cranial manipulation on two (plugged ear), secondary to an upper to the angle was present bilaterally. visits, and was then referred to me for respiratory infection or altitude change, Her diagnosis was of turgescence of Eustachian tube manipulation in late June and immediate post adenoidectomy. both eustachian tubes. of 1994. The procedure requires only 10-20 I explained to the patient the procedure Our examination revealed no seconds to do and it is uncomfortable but I was going to recommend, and also the inflammation on oral visualization, not painful. A pumping action with the possibility there might not be any external ear canal was not inflammed. index finger tip 4-5 times over the improvement. She understood the There was tenderness medial to the eustachian opening in the fossa of situation and requested that I go ahead mandible and anterior to the angle Rosenmuller. The procedure with the treatment. bilteral. occasionally requires repetition. 0 During the treating procedure, there The treatment procedure was done was evidence of soft tissue adhesions bilaterally and revealed large adenoids. In Memoriam bilaterally over the fossi. These were The right fossa felt congested, and it was broken and the tube was pumped. difficult to identify the eustachian Rachel (Woods) Harwood, DO Hearing and relief from the plugged opening. We did a pumping over it. The feeling was improved in the right ear left fossa was mildly congested, the Rachel (Woods) Harwood, 83 passed immediately following the treatment. eustachian opening was palpated and away November 8, 1995. The other ear was treated on two pumped. No adhesions were identified. Dr. Harwood was a 1934 graduated subsequent visits with relief of Three days after the procedure, he of the Des Moines Still College of symptoms. To my knowledge, there has broke out with chicken pox and was Osteopathy and Surgery and in the same been no recurrence of the patient's given Zovirax which halted further lesion year married Dr. John Woods. They development. He had one additional symptoms. practiced and taught in Des Moines until cranial treatment a week after the 1958 when they moved to Macon, eustachian manipulation. Missouri to do a research project. Her Case History #3 His mother returned with him on specialty was osteopathic pediatrics. In At age six months, B.F.D. developed October 11, 1994, reporting that there 1963 they settled in McCall, Idaho. Dr. chronic nasal congestion, diagnosed as had been no recurrence of fever or ear Rachel practiced there and was preceded due to allergies. At 9-10 months of age drainage since June, until the past week in death by Dr.John in 1971. She married he began having febrile illnesses and when he was febrile one day and had ear Ted Harwood of McCall in 1979 until was given antibiotics, 3-4 series in a 2-3 drainage. At this time, he had had an his passing in 1988. From that time on, month period. At age one year, febrile upper respiratory infection for two she lived in Portland, Oregon and lastly illness became more frequent and he weeks. He had been on antibiotics for in Bellingham, Washington. was on antibiotics almost continuously. ten days, primarily because the family She is survived by Dr. Donald Woods, If he was taken off antibiotics for 2-3 went to visit a relative who was Kennewick, WA, Dr. John Woods of days, he became febrile. immunocompromised. She reported that Mesa, AZ, Dr. Ronald Woods of Des In January, 1994, at age 15 months he he had had an upper respiratory infection Moines, IA, Anne (Harwood) Blackwell was seen by a DO Otorhinolaryn twice during the summer without fever of Cheyenne, WY, Stan Harwood of gologist. He was put on antibiotics for or ear drainage. Littleton, CO, 13 grandchildren and six weeks using a different one every Ear examination was difficult because many great grandchildren. two weeks. The fever returned the third he remembered his last visit. There was Memorial contributions may be made day after discontinuance. mild drainage present. The eustachian to the Osteopathic Center for Children, On February 21, 1994, myringotomy manipulation was repeated bilaterally. 8030 Girard A venue, LaJ olla, CA 92037. tubes were placed in both ears. The fevers The adenoids were still very large, the The Academy sends its deepest continued with ear pain, puffy face and fossa were identified and the pumping sympathy to Dr. Harwood's family.□ drainage from both ear tubes. He was procedure accomplished. 28/AAO Journal Winter 1995 continued from page 12 elements of the inner man. His recent caring and compassion seemed to set the book, Healing Words: The Power of stage for healing. Experiments with harsh, fault-finding attitude toward Prayer and the Practice of Medicine patients showed that prayer positively others. documents his collection of worldwide affected blood pressure, wound healing, Conscience can be viewed as the moral research in this field. He also reveals his heart attacks, headaches and anxiety. link between spirit and soul. When our personal struggles and conclusions based Dr. Dossey stated: "These data are so conscience is clear and we live according on the findings of his research. "I found impressive, I regard them as among the to its dictates, we have peace of mind. an enormous body of evidence: over 100 best-kept secrets of medical science." When it is violated, we feel guilt and experiments exhibiting the criteria of Dr. Dossey decided that not to employ shame, which are spiritual emotions good science, many conducted under prayer with his patients was the arising out of our inherent knowledge of stringent laboratory conditions, over half equivalent to deliberately withholding a God, the Law-giver. Guilt is an anxious of which showed that prayer brings about potent drug or surgical procedure. "I felt emotion in which we fear abandonment significant changes in a variety of living I should be true to the traditions of (loss of relationship) by the Law-giver. beings."13 scientific medicine, which means going Shame is a depressive emotion in which He stated in his book, "What was I through scientific data and not around we experience or grieve the it." He invented a prayer ritual, loss of self-esteem by our asking for God's will to be failure to live up to the THE WHOLEPERSON: done in the lives of patients THESPIRIT expectations of the Lawmaker. he was about to see on early /_ Those feelings, if left .... morning hospital rounds, as SPIRff unresolved, can result in .... well as his office patients. physical disease, usually a: HOLY' HUMAN' Never once did he pray for mediated through the a: SPIRIT SPIRIT Cl.) r z specific outcomes. "May the t • CONSCIENCE C autonomic nervous system. . best possible outcome ./ .... == The clear lesson of both . c:c prevail" was the strategy he ""'z scripture and experience is that Q preferred, not specifying what we are incapable of living z 3: :i "best" meant. The effects of emotionally and spiritually prayer did not depend on healthy lives on our own. . ~ .I ' whether the praying person Because of our sinful nature, was in the presence of the we will make wrong choices Q► c:, object of prayer or far away; and violate our consciences. =l.&.I m .... healing could take place on So how do we, as DOs, :::) 0 site or at a distance. approach and treat this spiritual Dr. Dossey expressed part of the inner man? First, we his personal belief that must be aware of this spiritual patients do not wish to bring entity in all suffering patients. In the personally going to do with this their religion into their relationship with May issue of Family Practice information? Was I going to pray for my their physician. However, in a recent Management, a study revealed that 95 patients or not? For years I had ignored study among elderly patients, 78 percent percent of Americans believe in God prayer. I considered it an arbitrary of the respondents said they would and 80 percent consider religion to be optional frill that simply was not in the appreciate their personal physician "important" or "very important" in their same league as drugs and surgery. I had praying with them during times of stress. 12 lives. Second, the DO needs to approach tried to escape spiritual or religious Dr. Dossey believes that, in addition to the patient in a non-threatening and influences in healing, fancying myself a providing medical expertise to patients, unprejudicial manner and be a good scientific physician." his job is to render emotional and listener. Third, the DO should assess Dr. Dossey' s research showed that psychological support as well. Patients patients according to their individual prayer takes many forms. Results who want more support may ask the needs, be flexible, use encouragement occurred not only when people prayed physician to become involved at deeper and a positive, caring approach with an for an explicit outcome, but also when levels, but it is best that they take the attitude of prayerfulness. they prayed fornothing specific. A simple initiative rather than the doctor. Dr. Larry Dossey is a medical doctor "Thy will be done" or merely an attitude Whatisprayer?PrayerisaskingGod's who has spent most o his professional of prayerfulness, an all-pervading sense will. The purpose of prayer is not to career researching and documenting the of holiness and a feeling of empathy, change His mind. Prayer, when practiced
Winter 1995 AAO Journal/29
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cells, cells, by by These These Still. Kirksville, MO. AT. Still Publishing, 12. Sadler, William S., MD, The 1908. Physiology of Faith and Fear or The Mind in Health and Disease. Chicago, 1913. lassifieds 11. Carl A. Hammerschlag, MD, The Dancing Healers: A Journey to Spiritual 13. Heffel, Leonard E. Opportunities in WANTED: OMM Specialist Healing with Native Americans. New York, Osteopathic Medicine. Louisville, KY: to join established OMM practice. No Vocational Guidance Manuals, 1974. NY. Simon and Schuster, p. 15. nights, weekends or hospital work. Good 12. Cheyn Damon Onarecker, MD and 14. Belshaw, Dr. Chris; Osteopathy: Is it salary and buy-in opportunities. Looking Bella Cativa Sterling, MD, Family Practice for you? for full-time physician but part-time Management. Vol. 2, No. 5, May, 1995, pp. 15. Hammerschlag, MD, Carl A. The Theft welcomed. Practice emphasizes wellness 44-49. of the Spirit: A Journey to spiritual healing and preventative medicine. Facility is 13. Larry Dossey, MD, Healing Words: with native Americans. Simon & Schuster, being designed with consideration to The Power of Prayer and The Practice of New York. color and environment and will house Medicine. San Francisco, CA. Harper, pp. 16. Hammerschlag, MD, Carl A. The mental health professionals, massage xv-xviii, xx, 2, 27. Dancing Healers: A Journey to spiritual therapist and family physicians. A healing with native Americans. Simon & surgery suite is available for training in Schuster, New York. laser surgery, Fantastic Opportunity! Bibliography 17. Sigerist, Dr. Henry E. Man and Contact: Denise D. Cantin, DO at (508) 01. Barker, Kenneth, General Editor; The Medicine: An introduction to medical 842-8118. NIV Study Bible, New International Version; knowledge. New York. Grand Rapids, Ml. 18. Rather, L. J. Mind and Body in Family Practice Physician 02. Dossey, Larry, MD; Healing Words: Eighteenth Century Medicine: A Study The Power of Prayer and The Practice of for multi-modality holistic medical BasedonJeromeGaub'sDeregiminementis. Medicine; Harper San Francisco. practice. Willing to learn nutrition. University of California Press, Berkeley and Osteopathic skills required. Build your 03. Dossey, Larry, MD; Meaning & Los Angeles, 1965. pp. 15 and 16. own following in our medical setting. Medicine: A Doctor's Tales of Breakthrough 19. Jones, Bob E., CAE Osteopathic and Healing; New York: Bantam Books, Great entrepreneurial opportunity. Call Medicine: The Premier Profession. Times 1991. Dr. BarbaraGordon-Cohenat(914) 352- Journal Publishing Company, Oklahoma 0063 or FAX (914) 352-1099. Rockland 04. Elias, Marilyn; "Pessimism linked to City, Oklahoma. County, New York. early death"; USA Today, San Diego, March 20. Leavitt, M.D., Sheldon. Psycho 23, 1995. Therapy in the Practice of Medicine and Director of OMT Services 05. Harakal, John H. DO, FAAO; "What Surgery. Magnum Bon um Company, IsOsteopathyToBe?"(TheNorthupLecture, Chicago, 1907. Maine: Director of OMT service in small, 1988 AOA Convention). community-based hospital providing 21. Webster, DO, George V. Sage Sayings inpatient consultation along with an 06. Kuchera, William A. DO, F AAO; "The of Still. Wetzel Publishing Co., Inc., Los outpatient practice. The director will Triune Profession" (Northup Memorial Angeles. Lecture, 1992 AOA Convention) AAO redefine the service, expand outpatient 22. Still,A.T.: Philosophy of Osteopathy. Journal, Summer 1993, p.11. volume and be involved in the Kirksville, MO: AT. Still Publishing, 1899. interdisciplinary development of hospital 07. Reese, Randy, MD and Minirth, Frank, 23. Northrup, DO, FAAO, George W. MD; Growing Into Wholeness: Putting body, programs. Osteopathic Medicine: An American mind and spirit back together; Chicago. Reformation. Chicago. AOBSPOMM Certification preferred 08. Still, AT.; Autobiography of Andrew 24. Cayce, J. Gail. Osteopathy: and/or board certification in family T. Still; Kirksville, MO 1908. Comparatice Concepts - AT. Still and practice. 09. Schwartz, Tony; What Really Matters: Edgar Cayce. Searching for Wisdom in America; New 25. Mind -Body Connection; "Larry Located in the heart of the Maine lakes York. Dossey MD Speaks on Efficacy of Prayer" region, one hour to skiing and one hour 10. Barnhart, Clarence L., and Barnhart, (Fall 1994). to the Maine coast. Competitive salary Robert K.; The World Book Dictionary: 26. Onarecker, Cheyn Damon, MD, and and benefits. Volume two L-Z; Chicago. Sterling, Bella Cativa, MD: Vol. 2, No. 5, 11. Jones, Bob E. The Difference a D.O. May, 1995. Family Practice Management, Send resume to: Waterville Osteopathic Makes: Osteopathic Medicine in the 27. Moyers, Bill: Healing and The Mind. Hospital, Office of the Chief Executive Twent ieth Century. Times-Journal Officer, Kennedy Memorial Drive, New York: Doubleday, 1993. 0 Publishing Company, Oklahoma City, Waterville, Maine, 04901. Oklahoma. Winter 1995 AAO Journal/31 The AAO Journal Index 1991 - 1995 A Publication of the American Academy of Osteopathy By Author: AAO, Coffey, David DO, CSPOMM Heilig, David DO (under the pseudonym I.D. "Opportunities and Issues for Osteopathic "Trigeminal Neuralgia" Volume 5, Number 4, "Jack and Jill; A Conversation Overheard on the Hospitals" Volume 4, Number I, Spring 1994; pp. Winter, 1995; pp. 26-27 Way 'Up the Hill'" Volume 3, Number 2, 23-25 Summer 1993; pp. 20, 23-24 Corbett, Scott R. (medical student) Ammann-Hasbrouck, Lynnne EdD Hessler, Dallas Dan DO "ls Osteopathic Education Ready for its Next "Will Your Recipe even be in the Cookbook?" Century?" Volume 2, Number 2, Summer 1992; "The Nature of Fascia and the Role of Lower Volume 2, Number 3, Fall 1992; pp. 14-15 pp.16-17 Extremity Fascia in Low Back Pain" Volume 5, Number3, Fall 1995; pp.15-19 Astell, Louise W. DO Cummings, III, Charles H. DO Hicks, Laurence V. DC "Try the Best First" Volume 2, Number 2, Summer "A Tensegrity Model for Osteopathy in the Cranial 1992; pp. 21-25 Field" Volume 4, Number 2, Summer J994; pp. "A Description of the Common Compensatory 9-13, 24-27 Pattern in Relationship to the Osteopathic Postural Baker, John T. DO, FAODME Examination" Volume 3, Number 4, Winter 1993; DeFeo, Guy A. DO "The Centennial Celebration, The Crime of the pp, 18-23 Century" Volume 3, Number I, Spring 1993; pp. "Chronic Upper Extremity Pain" Volume 5, Hruby, Raymond J. DO, FAAO 23,25 Number 1, Spring 1995; pp. 13, 28-29 "Pathophsysiologic Models: Aids to the Selection Bensky, Daniel DO "A Description of the Common Compensatory of Manipulative Techniques" Volume I , Number Pattern in Relationship to the Osteopathic Postural 3, Fall 1991 ; pp. 8-10 "Asthma Treated by Visceral Manipulation" Examination" Volume 3, Number 4, Winter 1993; Volume 5, Number I, Spring 1995; pp. 15-17 pp. 18-23 "Osteopathic Identity: Finding the Pony" Volume 3, Number 4, Winter 1993; pp. 9-12 Blood, Stephen D. DO, F AAO Denslow, J.S. DO Hulett, G. D. DO "Osteopathic Medicine: The Three-Dimensional "Management of the Cervical Area" Volume 4, Approach" Volume 5, Number 4, Winter, 1995; Number 3, Fall 1994; pp. 22-23 "The Lesion" Volume 3, Number 3, Fall 1993; pp. pp. 9-12, 30-32 23 Dott, Gregory A. DO, FAAO Bucci, Luke R. PhD, CCN Johnson, Ken DO "Axoplasmic Transport" Volume 5, Number 2, "Glucosamine - A New Potent Nutraceutical for Summer 1995; pp. 9-13 "An Integrated Approach for Treating the OB Connective Tissues" Volume 3, Number 2, Patient: Treating the Five Diaphragms of the Body, Earl, Daniel T. DO Summerl993;pp. 17,2 7 Part I" Volume I , Number 4, Winter 1991; pp. 6-9 Buser, Boyd R. DO "Three-Dimensional Counterstrain Lifts (3-DCL) "An Integrated Approach for Treating the OB Theoretical Concept and Applications" Volume 5, Patient; Treating the Five Diaphrarns of the Body, "A Patient with Bilateral Shoulder Pain" Volume 2, Number 2, Summer 1995; pp. 23-27 Number 2, Summer 1992; pp. 8, 26 Part II" Volume 2, Number I , Spring 1992; pp. Ettlinger, Hugh DO 10-16 "Lower Back Pain in an Elderly Patient with Jones, Laurie Beth Complicated History" Volume 3, Number I, Spring "OMM Residency Training and Certification" 1993; pp. 13-14 Volume 5, Number 3, Fa11 1995; pp. 30-31 "Integrating OMT into the Hospital Setting" Carlson, J. Michael DO Feely, Richard A. DO Volume 3, Number I, Spring 1993; pp. 20 "Three-Dimensional Counterstrain Lifts (3-DCL) "Low Back Pain" Volume 2, Number 3, Fall 1992; "Patient Education is Vital to Osteopathy's Future" Theoretical Concept and Applications" Volume 5, pp. 8,26 Volume 2, Number 4, Winter 1992; pp.10-11 Number 2, Summer 1995; pp. 23-27 Ferguson, Andrew DO, MRO "Why the Osteopathic Profession needs a Triple By-pass in Order to Survive" Volume I , Number Carlson, James A. DO, FAOAS "The Tightrope Walk of Osteopathy" Volume I, 4, Winter 1991; pp. 10 "Three-Dimensional Counterstrain Lifts (3-DCL) Number 3, Fall 1991; pp. 17-18 Theoretical Concept and Applications" Volume 5, Keller, James A. DO Number 2, Summer 1995; pp. 23-27 "Cranial Osteopathy: A New Perspective" Volume I, Number 4, Winter 1991; pp. 12-16 "Osteopathic Medicine" Volume 3, Number 3, Fall Carlton, Catherine K. DO, FAAO 1993; pp. 9-11, 18-20 Greenman, Philip E. DO, FAAO "Pioneer Women in Medicine" Volume 3, Number Kelso, Albert F. PhD " 'Who is to Blame?' Revisited" Volume 4, 2, Summer 1993; pp. 24-25 Number 4, Winter 1994; pp. 21 "Researching the Effectiveness of Osteopathic Health Care in Practice" Volume 3, Number l , Carruthers, Richard DO, MNZRO Habenicht, Ann L. DO Spring 1993; pp. 8-11 "Osteopathic Research in New Zealand" Volume "Colitis" Volume 3, Number 2, Summer 1993; pp. Korr, Irvin M. PhD 2, Number I , Spring 1992; 21-22 19, 25 "The Supremes of A.T. Still" Volume 1, Number Chapello, Isabelle A. DO, FAAO Haman, Jerry L. DO 1, Summer 1991; pp. 7-8 "Perceptions of Osteopathic Women Physician "An Osteopathic Approach to Treating Kuchera, Michael DO, FAAO Leaders: Current Status and Future Directions" L. Chondromalacia-Patellae with Counterstrain Volume 4, Number 3, Fall 1994; pp. 15-19, 28-32 Manipulation" Volume 4, Number I, Spring 1994; "Osteopathic Green: Applying the Philosophy of A.T. Still" Volume 2, Number 2, Summer 1992; pp. Chila, Anthony G. DO, FAAO pp, 26-27 7, 27 "Quality of Care: An Assessment of the Hayes, Catherine DO "New OMM Residency-Plus-One Offers Much to Contributions of Osteopathic Medicine" Volume 4, "The Passionate Tale of Man's Love/Hate Number 2, Summer 1994; pp. 22-23 the Profession" Volume 2, Number 4, Winter Relationship with Gravity, or ... "When Harry Met 1992;p .9 Clark, Robert C. DO Glenda" Volume 5, Number I, Spring 1995; pp. 22-23 "More than Mud, Mules & Manipulation" Volume "Review of the 1993 Journal of the New Zealand 2, Number 4, Winter 1992; pp. 24-27 Register of Osteopaths" Volume 4, Number 4, Heatherington, J. Scott DO Kuchera, William A. DO, FAAO Winter 1994; pp. 13-14 "Manipulation of the Eustachian Tube" Volume 5, "We Need National Heath - Not National Health Number 4, Winter, 1995; pp. 28-29 "The Triune Profession" Volume 3, Number 2, Summer 1993; pp. 9-14 Insurance" Volume 3, Number 3, Fall I 993; pp. "Let's Return to the Basics" Volume I, Number 4, 25-27 Winter 1991; pp. 18-19 Lee, Robert P. DO "AAO World Report" Volume 3, Number I, "A Report to the Statutory Advisory Committee on Spring 1993; pp.21 Medical Care" Volume I, Number I, Winter 1991; pp. 13-14 32/AAO Journal Winter 1995 "Primary & Secondary Respiration" Volume 2, Ostrow, Gary L. DO Tsompanidis, Antonios J. DO Number 4, Winter 1992; pp. 12-16 "Infant Head Shaping" Volume I, Number 2, "Somatic Dysfunction: A Neurophysiologic & "Postpartum Facial Palsy" Volume 4, Number 2, Spring 1991; p. 12 Osteopathic Overview" Volume 2, Number 2, Summer 1994; pp. 19-21 Ostrow, Gary L. DO, FAAO Summer 1992; pp. 9-10 "Scoliosis" Volume 3, Number 4, Winter 1993; pp. Typaldos, Stephen DO 14-15 "Challenges and Burdens" Volume 5, Number I, Spring 1995; pp. 9-12, 26-27 "Continuum Technique" Volume 5, Number 2, "Primary & Secondary Respiration" Volume 3, Summer 1995; pp. 15-19 Number I, Spring 1993; pp. 17-19, 27 Pelkey, Zina DO "Triggerband Technique" Volume 4, Number 4, "OMM Residency Training and Certification" Lemley, William W. DO Winter 1994; pp. 15-18, 28 Volume 5, Number 3, Fall 1995; pp. 30-31 "Acute Lumbosacral Strain" Volume 4, Number I, "Introducing the Fascia) Distortion Model" Pratt-Herrington, Dale DO Spring 1994; pp. 28-29 Volume 4, Number 2, Summer 1994; pp. 14-18, Lippincott, H. A. DO "The Effect of Osteopathic Manipulative 30-36 Treatment in the Post Abdominal Surgical Patient" van Deursen, L. L. J et al "Case of Birth Injury or Cranial Trauma" Volume Volume 5, Number 3, Fall 1995; pp. 9-13 .M. 3, Number 1, Spring 1993; pp. 15 Ramirez, Maurice A. DO, et al "The Value of Some Clinical Tests of the Lipton, James Andrew DO, CSPOMM, LCDR, Sacroiliac Joint" Volume I, Number 3, Fall 1991; "Osteopathic Medicine: A Century Old Prophesy pp. 13-16 "The Cranial Rhythmic Impulse and Headache: A of Modem Health, Nutrition and Exercise Wallace, Elaine M. DO Synthesis for Clinicians and Scientists Working Principles" Volume I, Number 2, Spring 1991; pp. Toward Mutual Education" Volume 4, Number 3, 4-5 "hnmune System" Volume 4, Number 4, Winter Fall 1994; pp. 9-13, 24-26 Richardson, Martyn E. DO, FACOP 1994; pp. 22-23 McCole, George Malcohn DO "An Imaginary Talk" Volume 4, Number 1, Spring Willard, Asa DO "Definitions of Osteopathy as a School of 1994; pp. 9-14 "Observations on A.T. Still" Volume 2, Number 1, Medicine" Volume 3, Number 4, Winter 1993; pp. Spring 1992; pp. 17-19 25-26 Rolles, John DO Winterson, B. J, PhD McConnell, Carl P. DO "A New Challenge to Osteopathy" Volume 5, Number I, Spring I 995; pp. 20-22 "A Hypothesis for the Faciliated Segment Based "Mother Still" Volume 5, Number 4, Winter, 1995; Sanders, Elizabeth C. OMM Fellow Upon Biological Principles Associated with p.22 Turnorigenesis" Volume 4, Number 4, Winter McParland, J. M. DO, MS "Anatomy, Asthma and Dysautonomia" Volume 2, 1994;pp. 9-12, 26-28 Number 4, Winter 1992; pp. 8-9, 28 Woodwall, Pearcy H. MD, DO "IBIS (Interactive Bodymind Information System" Schnack, Tom H. CPA Volume 4, Number 4, Winter 1994; pp. 19-20 "Osteopathy - How it Differs from other Manual Millard, F. P. DO "Evaluation of Managed Care Contracting" Methods" Volume 4, Number I , Spring 1994; pp. Volume 1, Number 4, Winter 1991; pp. 10-11 30-31 "What Twenty-Five Years of Practice Has Taught Me" Volume 2, Number 3, Fall 1992; pp. 21, 26 "Strategic Planning in the Medical Profession" Wright, Harlan O.L. DO Volume 1, Number 4, Winter 1991; pp. 18-19 "Insanity or Hypoglycemia?" "From 'Practical Visions' "Volume 5, Number 3, Fall 1995; p. 21 Sept, Karen E. DO Volume I, Number 2, Spring 1991; pp. 6-7 Miller, Ted D. DO "Sinusitis" Volume 4, Number 3, Fall 1994; pp. "Cystic Fibrosis and a Victory for Osteopathic 20-21 Methods: A case History" Volume 1, Number 3, "Osteopathy & Chronic Pain" Volume 2, Number Fall 1991; pp. 11-12 I, Spring 1992; pp. 8,9,22 Somner, Lillian DO "A Disease Which No Longer Exists" Volume I, Mills, Miriam MD "Ataxia and Facial Pain" Volume 3, Number 3, Number 4, Winter 1991; pp. 22-23 Fall 1993; pp. 13-14 "Stranger in a New Land" Volume 4, Number 2, "Rheumatoid Arthritis: The Incurable Disease?" Summer 1994; pp. 28-29 Stanley, Sharon Ann DO Volume 2, Number 2, Summer 1992; pp. 11-12 Mokler, D. J. PhD "Demonstration of the Fundamental Tenen! of "Panic Attack - Another View" Volume 3, Osteopathy" Volume 5, Number 3, Fall 1995; pp. Number 1, Spring 1993; pp. 24-25 "A Hypothesis for the Faciliated Segment Based 26-27 Upon Biological Principles Associated with "The Patient Who Wouldn't Give Up" Volume 2, Tumorigenesis" Volume 4, Number 4, Winter Stiles, Edward G. DO, FAAO Number I, Spring 1992; pp. 6-7 1994; pp. 9-12, 26-28 "Outcome Data for Patients Experiencing Chronic Yonuschot, G. PhD Morey, Lloyd DO Pain" Volume 4, Number I , Spring 1994; pp. 32-33 "A Hypothesis for the Faciliated Segment Based "Who Will Hatch Our Students?" Volume 1, Still, A. T. MD Upon Biological Principles Associated with Number 3, Fall 1991; pp. 6-7 "How Osteopathy was Evolved" Volume 2, Tumorigenesis" Volume 4, Number 4, Winter 1994; pp. 9-12, 26-28 Neptune-Ceran, Regine DO Number 4, Winter 1992; pp. 22-23 Young, M. D. DO "The Effect of Osteopathic Manipulative "Philosophy of Osteopathy" Volume 3, Number 2, Treatment in the Post Abdominal Surgical Patient" Summer 1993; pp. 15-16 "The Experimental Method of Learning" Volume 5, Number 2, Summer 1995; pp. 21, 34 Volume 5, Number 3, Fall 1995; pp. 9-13 Teitelbaum, David DO Norton, James M. PhD., et al "Clinical Findings in the Suspect Patient with Low "Characterization of the Cranial Rythrnic hnpulse Back Pain" Volume I , Number2, Spring 1991; pp. in Healthy Human Adults" Volume 2, Number 3, 8-9 Fall 1992; pp. 9-12, 26 "Anatomic Metaphors: Clues to the Emotions of O'Connell, Judith A. DO Our Patients" Volume 1, Number 1, Winter 1991; p.6 "Integrating Osteopathic Medicine into the Second 100 Years" Volume 2, Number 4, Winter 1992; Tenpenny, Sherri DO pp. 18-19 "Severe Left Hip Pain" Volume 5, Number 2, "Strategy for Addressing Third-Party Payors on Summer 1995; pp. 32-34 OMT" Volume 2, Number 3, Fall 1992; pp. 16-17 Tettambel, Melicien A. DO, FAAO Osborn, Gerald G. DO, MPhil, FACN "Structural and Hormonal Influences on Pelvic "Manual Medicine and its Role in Psychiatry" Mechanics in Labor and Delivery" Volume 5, Volume 4, Number I, Spring 1994; pp. 16-21 Number 4, Winter, 1995; pp. 17-21
Winter 1995 AAO Journal/33 The AAO Journal Index 1991 - 1995 A Publication of the American Academy of Osteopathy By Subject: Abdomen "Three-Dimensional Counterstrain Lifts (3-DCL} "The Experimental Method of Learning"; Young, Theoretical Concept and Applications"; Carlson, M. D. DO; Volume 5, Number 2, Summer 1995; "The Effect of Osteopathic Manipulative James A. DO, FAOAS; J. Michael Carlson, DO pp. 21, 34; Treatment in the Post Abdominal Surgical Patient"; and Daniel T. Earl, DO Volume 5, Number 2, Pratt-Herrington, Dale DO; and Regine 'The Lesion"; Hulett, G. D. DO; Volume 3, Neptune-Ceran, DO Volume 5, Number 3, Fall Cranial Number 3, Fall 1993; pp. 23; Asthma "Cranial Osteopathy: A New Perspective"; Ferguson, Andrew DO, MRO; Volume 1, " 'Who is to Blame?' Revisited"; Greenman, Philip "Anatomy, Asthma and Dysautonomia"; Sanders, Number 4, Winter 1991; pp. 12-16; 12-16 E. DO, FAAO; Volume 4, Number 4, Winter Elizabeth C. OMM Fellow; Volume 2, Number 4, 1994; pp. 21; Winter I 992; pp. 8-9, 28; 8-9, 28 "The Cranial Rhythmic Impulse and Headache: A Hospital OMT Axoplasmic Synthesis for Clinicians and Scientists Working Toward Mutual Education"; Lipton, James "Inte_grating OMT into the Hospital Setting"; Jones, "Axoplasmic Transport"; Dolt, Gregory A. DO, Andrew DO, CSPOMM, LCDR, MC, USN*; Laune Beth; Volume 3, Number I, Spring 1993; FAAO; Volume 5, Number 2, Summer 1995; pp. pp. 20; 9- 13; Cranial Rythmic Impulse "Characterization of the Cranial Rythmic Impulse Infant Head Shaping Bilateral Shoulder Pain in Healthy Human Adults"; Norton, James M. "Infant Head Shaping"; Ostrow, Gary L. DO; "A Patient with Bilateral Shoulder Pain"; Buser, PhD., et al; Volume 2, Number 3, Fall 1992; pp. Volume I, Number 2, Spring 1991; p. 12; 12 Boyd R. DO; Volume 2, Number 2, Summer 1992; 9-12, 26; 9-12, 26 Low Back Pain pp.8,26;8,26 Cystic Fibrosis Case Study "Clinical Findings in the Suspect Patient with Low "Cystic Fibrosis and a Victory for Osteopathic Back Pain"; Teitelbaum, David DO; Volume I, "Acute Lumbosacral Strain"; Lemley, William W. Methods: A case History"; Wright, Harlan O.L. Number2, Spring 1991; pp. 8-9; 8-9 DO; Volume 4, Number I, Spring 1994; pp. 28-29; DO; Volume I, Number3, Fall 1991; pp. 11-12; 11-12 "Low Back Pain"; Feely, Richard A. DO; Volume "Ataxia and Facial Pain"; Somner, Lillian DO; Diaphragms 2, Number 3, Fall 1992; pp. 8, 26; 8,26 Volume 3, Number3, Fall 1993; pp. 13-14; "An Integrated Approach for Treating the OB "The Nature of Fascia and the Role of Lower "Colitis"; Habenicht, Ann L. DO; Volume 3, Patie~r Treating the Five Diaphragms of the Body, Extremity Fascia in Low Back Pain"; Hessler, Number 2, Summer 1993; pp. 19, 25; Part I ; Johnson, Ken DO; Volume I, Number 4 Dallas Dan DO; Volume 5, Number 3, Fall 1995; Winter 1991; pp. 6-9; 6-9 ' pp.15-19; "Demonstration of the Fundamental Tenen! of Osteopathy"; Stanley, Sharon Ann DO; Volume 5, Emotions Manipulative Techniques Number 3, Fall 1995; pp. 26-27; "Anatomic Metaphors: Clues to the Emotions of "Pathophsysiologic Models: Aids to the Selection "Immune System"; Wallace, Elaine M. DO; Our Patients"; Teitelbaum, David DO; Volume I, of Manipulative Techniques"; Hruby, Raymond J. Volume 4, Number 4, Winter 1994; pp. 22-23; Number I, Winter 1991; p. 6; 6 DO, FAAO; Volume I, Number 3, Fall 1991; pp. 8-10; 8-10 Eustachian Tube "Insanity or Hypoglycemia?" Medical Care Report ; Wright, Harlan O.L. DO; Volume 1, Number 2, "Manipulation of the Eustachian Tube"; Spring 1991; pp. 6-7; 6-7 Heathenngton, J. Scott DO; Volume 5, Number 4, "A Report to the Statutory Advisory Committee on Winter, 1995; pp. 28-29; Medical Care"; Lee, Robert P. DO; Volume I, "Lower Back Pain in an Elderly Patient with Number I, Winter 199 1; pp. 13-14; I 3-14 Complicated History"; Buser, Boyd R. DO; Faciliated Segment Volume 3, Number 1, Spring 1993; pp. 13-14; Northup lecture "A Hypothesis for the Faciliated Segment Based "Postpartum Facial Palsy"; Lee, Robert P. DO; Upon Biological Principles Associated with "Challenges and Burdens"; Ostrow, Gary L. DO, FAAO; Volume 5, Number 1, Spring 1995; pp. Volume 4, Number 2, Summer 1994; pp. 19-21; Tumorigenesis"; Yonuschot, G. PhD; D. J. Mokler, PhD and B.J. Winterson, PhD Volume 4, 9-12, 26-27; "Scoliosis"; Lee, Robert P. DO; Volume 3, Number 4, Winter 1993; pp. 14-15; Fascia! Distortion "Osteopathic Identity: Finding the Pony"; Hruby, Raymond J. DO, FAAO; Volume 3, Number 4, "Introducing the Fascia! Distortion Model"; Winter 1993; pp. 9-12; "Severe Left Hip Pain"; Tenpenny, Sherri DO; Typaldos, Stephen DO; Volume 4, Number 2, Volume 5, Number 2, Summer 1995; pp. 32-34; Summer 1994; pp. 14-18, 30-36; "Osteopathic Medicine: The Three-Dimensional Approach"; Blood, Stephen D. DO, FAAO; "Sinusitis"; Sept, Karen E. DO; Volume 4, From the Archives Number 3, Fall 1994; pp. 20-21; Volume 5, Number 4, Winter, 1995; pp. 9-1 2, "A New Challenge to Osteopathy"; Rolles, John 30-32; "Trigeminal Neuralgia"; Coffey, David DO, DO; Volume 5, Number I, Spring 1995; pp. 20-22; CSPOMM; Volume 5, Number 4, Winter, 1995; "The Triune Profession"; Kuchera, William A. DO, FAAO; Volume 3, Number 2, Summer 1993; pp. 26-27; "Case of Birth Injury or Cranial Trauma"; Lippincott, H. A. DO; Volume 3, Number I, pp. 9-14; Chronic pain Spring 1993;pp.15; Nutrition "Outcome Data for Patients Experiencing Chronic "Definitions of Osteopathy as a School of "Glucosamine - A New Potent Nutraceutical for Pain"; Stiles, Edward G. DO, FAAO; Volume 4, Medicine"; McCole, George Malcolm DO; Connective Tissues"; Bucci, Luke R. PhD, CCN; Number 1, Spring 1994; pp. 32-33; Volume 3, Number 4, Winter 1993; pp. 25-26; Volume 3, Number 2, Summer 1993; pp. 17, 27; Common Compensatory Pattern ''From 'Practical Visions' "; Millard, F. P. DO; Nutrition and Exercise "A Description of the Common Compensatory Volume 5, Number 3, Fall 1995; p. 21; Pattern in Relationship to the Osteopathic Postural "Osteopathic Medicine: A Century Old Prophesy Examination"; DeFeo, Guy A. DO; and Laurence "Management of the Cervical Area"; Denslow, of Modern Health, Nutrition and Exercise V. Hicks, DC Volume 3, Number 4, Winter 1993; J.S. DO; Volume 4, Number 3, Fall 1994; pp. Principles"; Ramirez, Maurice A. DO, et al; 22-23; Volume I, Number 2, Sprin_g 1991 ; pp. 4-5; 4-5 Continuum OB Patient "Mother Still"; McConnell, Carl P. DO; Volume 5 "Continuum Technique"; Typaldos, Stephen DO; Number 4, Winter, 1995; p. 22; ' Volume 5, Number 2, Summer 1995; pp. 15-19; "An Integrated Approach for Treating the OB Patient: Treating the Five Diaphrams of the Body, "Osteopathy - How it Differs from other Manual Counters train Part II"; Johnson, Ken DO; Volume 2, Number I, Methods"; Woodwall, Pearcy H. MD, DO: Sprin_g 1992; pp. 10-16; 1016 "An Osteopathic Approach to Treating Volume 4, Number I, Spring 1994; pp. 30-31; Chondromalacia-Patellae with Counterstrain Obstetrics Manipulation"; Haman, Jerry L. DO; Volume 4, "Philosophy of Osteopathy"; Still, A. T. MD; Number I, Sprin_g 1994; pp. 26-27; Volume 3, Number 2, Summer 1993; pp. 15-16;
34/AAO Journal Winter 1995 "Structural and Hormonal Influences on Pelvic "Somatic Dysfunction: A Neurophysiologic & "The Supremes of A.T. Still"; Karr, Irvin M . PhD; Mechanics in Labor and Delivery"; Tettambel, Osteopathic Overview"; Tsompanidis, Antonios J. Volume I, Number I, Summer 1991; pp. 7-8; Melicien A. DO, FAAO; Volume 5, Number 4, DO; Volume 2, Number 2, Summer 1992; pp. Winter, 1995; pp. 17-21; 9-10; 9-10 "The Tightrope Walk of Osteopathy"; Ferguson, Andrew DO, MRO; Volume I , Number 3, Fall OMM Residency Training Special Communication 1991; pp. 17-18; 17-18 "OMM Residency Training and Certification"; "A Disease Which No Longer Exists"; Wright, "We Need National Heath - Not National Health Ettlinger, Hugh DO; and Zina Pelkey, DO Harlan O.L. DO; Volume I , Number 4, Winter Volume 5, Number 3, Fall 1995; pp. 30-31; 1991; pp. 22-23; 22-23 Insurance"; Clark, Robert C. DO; Volume 3, Number 3, Fall 1993; pp. 25-27; "OMM Residency Training and Certification"; "AAO World Report"; Clark, Robert C. DO; "What Twenty-Five Years of Practice Has Taught Pelkey, Zina DO; Volume 5, Number 3, Fall Volume 3, Number I, Spring 1993; pp.21 ; Me"; Millard, F. P. DO; Volume 2, Number 3, I 995; pp. 30-31; "Evaluation of Managed Care Contracting"; Fall 1992;pp.21,26;2 1, 26 OMM Residency-Plus-One Schnack, Tom H. CPA; Volume I , Number 4, Winter I 991; pp. 10-11; "Who Will Hatch Our Students?"; Morey, Lloyd "New OMM Residency-Plus-One Offers Much to DO; Volume I, Number 3, Fall 1991; pp. 6-7; 6-7 the Profession"; Kuchera, Michael L. DO, FAAO; "How Osteopathy was Evolved"; Still, A. T. MD; Volume 2, Number 4, Winter 1992; p. 9; 9 Volume 2, Number 4, Winter 1992; pp. 22-23; "Why the Osteopathic Profession needs a Triple 22-23 By-pass in Order to Survive"; Jones, Laurie Beth ; Pain, Chronic Volume I , Number 4, Winter 1991; pp. 10; "Integrating Osteopathic Medicine into the Second "Osteopathy & Chronic Pain" ; Miller, Ted D. DO; "Will Your Recipe even be in the Cookbook?"; Volume 2, Number 1, Spring 1992; pp. 8,9,22; 8-9, 100 Years"; O'Connell, Judith A. DO: Volume 2, Number 4, Winter 1992; pp. 18-19; Ammann-Hasbrouck, Lynnne EdD; Volume 2, 22 Number 3, Fall 1992; pp. 14-15; Panic attack "ls Osteopathic Education Ready for its Next Tensegrity Century?"; Corbett, Scott R. (medical student); "Panic Attack - Another View"; Wright, Harlan Volume 2, Number 2, Summer 1992; pp.16-17; "A Tensegrity Model for Osteopathy in the Cranial O.L. DO; Volume 3, Number 1, Spring 1993; pp. Field"; Cummings, III, Charles H. DO; Volume 4, 24-25; "Jack and J ill: A Conversation Overheard on the Number 2, Summer 1994; pp. 9-13, 24-27; Way 'Up the Hill' "; Heilig, David DO (under the Philosophy pseudonym LD. Clare); Volume 3, Number 2, Triggerband Summer 1993; pp. 20, 23-24; "Osteopathic Green: Applying the Philosophy of " Triggerband Technique"; Typaldos, Stephen A.T. Still"; Kuchera, Michael L. DO, FAAO; "Let's Return to the Basics"; Heatherington, J. DO; Volume 4, Number 4, Winter 1994; pp. Volume 2, Number 2, Summer 1992: pp. 7, 27; 7, 15-18, 28; 27 Scott DO; Volume I , Number 4, Winter 1991; pp. 18-19; Upper Extremity Pain Psychiatry "More than Mud, Mules & Manipulation"; "Chronic Upper Extremity Pain"; DeFeo, Guy A. "Manual Medicine and its Role in Psychiatry"; Kuchera, Michael L. DO, FAAO; Volume 2, DO; Volume 5, Number I, Spring 1995; pp. 13, Osborn, Gerald G. DO, hil, FACN; Volume 4, MP Number 4, Winter 1992; pp. 24-27; 24-27 28-29; Number 1, Spring 1994; pp. 16-21; "Observations on A.T. Still"; Willard, Asa DO; Visceral Manipulation Research Volume 2, Number I, Spring 1992; pp. 17-19; "Asthma Treated by Visceral Manipulation"; "Osteopathic Research in New Zealand"; Bensky, Daniel DO; Volume 5, Number 1, Spring Carruthers, Richard DO, MNZRO; Volume 2, "Opportunities and Issues for Osteopathic 1995; pp. 15-17; Number I, Spring 1992; 21 -22; 21 -22 Hospitals"; AAO, ; Volume 4, Number I, Spring 1994; pp. 23-25; Women Physicians Respiration "Osteopathic Medicine"; Keller, James A. DO; "Perceptions of Osteopathic Women Physician "Primary & Secondary Respiration"; Lee, Robert Volume 3, Number 3, Fall 1993; pp. 9-11, 18-20; P. DO; Volume 2, Number 4, Winter 1992; pp. Leaders: Current Status and Future Directions"; Chapello, Isabelle A. DO, FAAO; Volume 4, 12-16; 12-16 "Patient Education is Vital to Osteopathy's Future"; Jones, Laurie Beth ; Volume 2, Number Number3, Fall 1994; pp. 15- 19, 28-32; "Primary & Secondary Respiration"; Lee, Robert 4, Winter 1992; pp.I 0-11; P. DO; Volume 3, Number I, Spring 1993; pp. 17-19, 27; "Pioneer Women in Medicine"; Carlton, Catherine K. DO, FAAO; Volume 3, Number 2, Summer Review 1993; pp. 24-25; "IBIS (Interactive Bodymind Information System"; "Quality of Care: An Assessment of the McParland, J.M . DO, MS; Volume 4, Number 4, Contributions of Osteopathic Medicine"; Chila, Winter 1994; pp. 19-20; Anthony G. DO, FAAO; Volume 4, Number 2, "Review of the 1993 Journal of the New Zealand Summer 1994; pp. 22-23; Register of Osteopaths"; _Clark, Robert C . DO; "Researching the Effectiveness of Osteopathic Volume 4, Number 4, Wmter 1994; pp. 13-14; Health Care in Practice"; Kelso, Albert F. PhD; Rheumatoid Arthritis Volume 3, Number I, Spring 1993; pp. 8-11; "Rheumatoid Arthritis: The Incurable Disease?"; "Stranger in a New Land"; Mills, Miriam MD; Wright, Harlan O.L. DO; Volume 2, Number 2, Volume 4, Number 2, Summer 1994; pp. 28-29; Summer 1992; pp. 11-12; 11-12 "Strategic Planning in the Medical Profession"; Sacroiliac Joint Schnack, Tom H. CPA; Volume 1, Number 4, Winter 1991; pp. 18-19; "The Value of Some Clinical Tests of the Sacroiliac Joint"; van Deursen, L. L. J. M. et al; "Strategy for Addressing Third-Party Payors on Volume I, Number 3, Fall 1991; pp. 13-16; 13-16 OMT''; O'Connell, Judith A. DO; Volume 2, Number3,Fall 1992;pp. 16-17; Scott Memorial Lecture "An Imaginary Talk"; Richardson, _Martyn E . DO, "The Centennial Celebration, The Crime of the FACOP; Volume 4, Number I, Spnng 1994; pp. Century"; Baker, John T. DO, FAODME; Volume 9-14; 3, Number I, Spring 1993; pp. 23, 25;
"Try the Best First"; Astell, Louise W. DO; "The Passionate Tale of Man's Love/Hate Volume 2, Number 2, Summer 1992; pp. 21 -25; Relationship with Gravity, or ... "When Harry Met 21-25 Glenda"; Hayes, Catherine DO; Volume 5, Number I, Spring 1995; pp. 22-23; Somatic Dysfunction "The Patient Who Wouldn't Give Up"; Wright, Harlan O.L. DO; Volume 2, Number I, Spring 1992; pp. 6-7;
Winter 1995 AAO Journal/35 A systema1:ic approach to balance, JANDA: proprioception and muscle function
Vladimir Janda, MD is recognized worldwide for his research linking muscle dysfunction and chronic pain syndromes. Janda emphasizes that muscle imbalances represent a systematic response of the locomotor system influencing musculoskeletal pain. Prof. Janda, along with Maria Vavrova, developed a program that uses specific techniques to restore muscle balance, joint stability and speed of muscle contraction. The Uniplane Rocher~(1), Wooden Wobble™(2), and ExerciseSandals (3) are balance devices progressively used in this program. The result is subconscious control of muscles responsible for postural maintenance and gait. The video programs "MuscleLe:ngthAssessment" an d "Sensory MotorStimulation" guide you through initial muscle assessment and QPTP later use of the balance devices. More The Conservative Care Specialists information is available in OPTP's new P.O. Box 4 7009, Minneapolis, MN 55447-0009 (612) 553-0452 catalog; call or write today. 1-800-367-7393 ©l NON-PROFIT ORG. J. American U.S. POSTAGE PAID Academy of PERMIT NO. 14 Osteopathy CARMEL, INDIANA 3500 DePauw Boulevard Suite 1080 Indianapolis, IN 46268-1136 ADDRESS CORRECTION AND FORWARDING REQUESTED