Julie Antonova Focused Clinical Multidisciplinary ISP Summary April 1, 2015 Introduction to Osteopathic Manipulative Medicine Background/Goals: My interest in completing this project and learning about osteopathy stems from my experiences observing osteopathic physicians during a Family Medicine rotation in my third year of medical school. Until that point, I was not aware of the existence of osteopathy – a system of medical practice that emphasizes treating an illness in the context of the whole body, and using manipulation techniques to facilitate healing. Having been practicing Reiki, a type of bodywork modality with a similar holistic perspective on health and the human body, I was naturally drawn to learning more about osteopathy. My goals for this project included the following: a) To develop an understanding of the history, philosophy and principles of osteopathic medicine b) To develop an understanding of how to perform an Osteopathic physical examination and make a diagnosis of somatic dysfunction (in addition, to have an overview of the different types of somatic dysfunctions) c) To recognize the indications for several commonly used osteopathic manipulative treatment (OMT) techniques – including soft tissue, myofascial release, muscle energy, counterstrain, cranial, articulatory, high‐velocity‐low‐amplitude, and lymphatic techniques d) To develop an understanding of how OMT can be incorporated into the management of conditions commonly treated by primary care physicians e) To develop an understanding of how osteopathic manipulative treatments can be used in the management of neurological disorders f) To gain the basic understanding of how to perform OMT techniques described above through direct practice in the clinical setting Clinical experiences: During the two months of my ISP, I spent six weeks in a Family Medicine clinic with Dr. Kurisu, Dr. Fleming, and Dr. Cyr and one week in a Neurology clinic with Dr. Alexander (the remaining week was spent at the Convocation). My patient encounters are summarized in the tables below. A) Family Medicine clinic Chief Concern Treatment Upper extremity edema (history of Axillary lymph node drainage, myofascial release to the breast cancer status post lumpectomy pectoralis major, shoulder joint and scapula and axillary lymph node dissection) Low back pain Sacroiliac joint decompression, lumbosacral decompression, balanced ligamentous tension to the lumbosacral region, muscle energy to the anterior innominate dysfunction, high‐ velocity‐low‐amplitude techniques to the lumbar spine Bilateral lower extremity edema Myofascial release to the lower extremities (from the level of (history of congestive heart failure) the ankles to the level of the knees) Iliotibial band syndrome IT band myofascial release Acute otitis media Mandibular drainage (Galbreath technique), auricular drainage technique Tension headache Suboccipital release, inhibition to the cervical paraspinal muscles and trapezius, muscle energy and high‐velocity‐low‐ amplitude techniques to the cervical spine Gastroesophageal reflux disease Myofascial release of the gastroesophageal junction, muscle energy to the diaphragm (doming of the diaphragm), T5‐T9 muscle energy/soft tissue/myofascial release (to normalize sympathetic innervation of the GI tract), decompression of the vagus nerve at the jugular foramen (to normalize regulation of gastric acid secretion) Acute sinusitis Frontal sinus drainage, maxillary sinus drainage, submandibular release, anterior/posterior cervical chain drainage, thoracic inlet myofascial release, thoracic pump Low back pain/pelvic pain associated Pelvic diaphragm release, pubic symphysis articulatory with pregnancy technique, sacroiliac joint decompression, lumbosacral decompression, sacral rocking Carpal tunnel syndrome Myofascial release to the transverse carpal ligament Post‐concussive syndrome Cranial techniques Cholelithiasis/cholestasis Myofascial release/balanced ligamentous tension techniques to the gallbladder and liver History of falls/balance difficulties Muscle energy and high‐velocity‐low‐amplitude techniques to C2, balanced ligamentous tension to the lumbar spine, cranial techniques Back, neck, and hip pain (history of Muscle energy and high‐velocity‐low‐amplitude techniques to MVA) the cervical spine and hip, balanced ligamentous tension and inhibition to the thoracic spine Cervical radiculopathy (due to bone Suboccipital release, occipitoatlantal decompression, muscle spur) energy and balanced ligamentous tension to the cervical spine, high‐velocity‐low‐amplitude technique to the 1st rib Temporomandibular joint dysfunction Counterstrain, balanced ligamentous tension and ligamentous articular strain techniques to the temporomandibular joint Vertigo Cranial techniques Paraplegia (history of spinal cord injury Myofascial release to the thoracic cage and diaphragm, colonic after an MVA), acute constipation stimulation technique, mesenteric release (ascending and descending colon) Sciatica (secondary to piriformis Counterstrain to the piriformis spasm) Low back pain (secondary to psoas Still technique to the psoas, counterstrain to the psoas and L1 spasm) Shingles (V1 distribution) Cranial techniques, trigeminal stimulation Hand weakness and limited range of Myofascial release and balanced ligamentous tension to the motion of the wrist (history of distal hand, wrist, and distal forearm radius fracture status post plate fixation, complicated by osteoarthritis) Low back pain (secondary to lumbar Balanced ligamentous tension and muscle energy to the lumbar spinal stenosis) spine Viral upper respiratory infection Venous sinus drainage, frontal lift, maxillary sinus drainage, anterior/posterior cervical chain drainage Upper back pain (following acute High‐velocity‐low‐amplitude technique to the thoracic spine, muscle strain while lifting weights) muscle energy to latissimus dorsi and ribs, myofascial release to scapula, soft tissue technique to cervical paraspinal muscles and trapezius 6‐day‐old infant with Cranial techniques, decompression of the vagus nerve at the sternocleidomastoid spasm and cranial jugular foramen (to normalize function of the lower esophageal strain pattern (due to positioning in the sphincter), inhibition and myofascial release to the uterus and/or birth trauma), sternocleidomastoid gastroesophageal reflux Low back pain (secondary to L2‐S1 Balanced ligamentous tension and gentle high‐velocity‐low‐ degenerative disc disease) amplitude technique to the lumbar spine and sacrum (Note: Patient came to clinic in a wheelchair, was unable to stand up straight due to pain. She reported significant decrease in pain immediately after treatment and was able to walk out on the exam room.) Tinnitus (secondary to restricted Cranial techniques motion of the temporal bones) Low back pain (secondary to multiple Balanced ligamentous tension and counterstrain to the lumbar herniated discs in the lumbar spine) spine and sacroiliac joints Dyspnea secondary to pulmonary Rib raising, muscle energy to ribs and diaphragm fibrosis Shoulder pain (history of labral tear), Balanced ligamentous tension and Spencer technique to the neck tension and headaches shoulder joint, suboccipital release, soft tissue to cervical paraspinal muscles and trapezius Plantar fasciitis Counterstrain and myofascial release to the plantar fascia Nasal and maxillary fractures, rib pain Cranial techniques, muscle energy to ribs, balanced (following bicycle accident), knee ligamentous tension/myofascial release to the knee osteoarthritis Sliding hiatal hernia Myofascial release to the stomach and diaphragm Ankle and hip pain (history of ankle Balanced ligamentous tension to the ankle sprain) History of myocardial infarction Myofascial release to the pericardium Vision loss (homonymous hemianopsia Cranial techniques (one of the goals is to normalize blood with macular sparing) following supply to the brain, especially occipital lobe) (Note: Patient ischemic stroke in the occipital cortex reported improved vision after several treatments.) 3‐year‐old boy with a history of Cranial techniques (with the goal of normalizing motion at the craniosynostosis (sagittal synostosis, sagittal suture and in general, restoring normal cranial diagnosed at approximately 10 months structure) of age; patient began developing (Note: Patient has been treated regularly since diagnosis of strabismus as a result of changes in synostosis was made, thus avoiding craniectomy.) cranial anatomy) Sensory and motor deficits – secondary Cranial techniques, myofascial release and balanced to Brown‐Séquard syndrome, caused by ligamentous tension to the upper extremities, muscle energy to air embolism at the level of C1 during the ribs radiofrequency neurotomy that patient (Note: Patient has been receiving regular treatment beginning underwent several years ago. Patient shortly after diagnosis. She had eventually transitioned from a was initially paralyzed in all four wheelchair to ambulating with a cane. She has also experienced extremities, with significant sensory progressive return of sensory function in all four extremities. For loss (loss of light touch, vibration, and example, when I initially met her, she reported a return of the proprioception on the ipsilateral side, sense of light touch in her fifth and fourth fingers on one hand. and loss of pain and temperature on the Two months later, she reported intact sensation to the level of contralateral side). the axilla, with associated improvements in strength, temperature sensation, stereognosis,