Intro to O.M.T. - New Trier Township High School

Learning ObjectivesReview Key Concepts behind OMTList at least 3 types of ManipulationDemonstrate competence diagnosingMechanical Back PainPerform manipulative therapy on Neck,Shoulder, Ankle, Upper back, Lower backand SacrumUse these skills to help your athletes

Basis of Manipulation“Osteopathy is nottreatingdiseases, it istreating people”A.T. Still, M.D. -1892

Concept AThe Body is a Unit

Concept BStructure and Function arereciprocally interrelated

The function of every tissuein the body is to moveEach part of the human body isdesigned to function efficientlyin relationship with every otherpart

Concept CThe Body possessesSelf-RegulatoryMechanisms

Concept DThe Body has the InherentCapacity to Defend andHeal itself

Concept EIf environmental changesOvercome the body’scapacity for selfmaintenance, diseasemay ensue

Concept FMovement of bodyfluids is essential tothe maintenance ofhealth

Concept GNerves play a crucial partin controlling the fluids ofthe body

Concept HThere are SomaticComponents of disease whichnot only manifest disease butalso contribute to maintenanceof the diseased state

Musculoskeletal SystemProvides frameworkPathway for:– vascular system– neural system– lymphatic system

FasciaConnective tissue layersContinuous from the base of skullto the feetLike taut curtains throughout thebodyThink Anatomically

Joint Ranges of MotionThree planes ofmotion– Flexion/Extension– Side bending(lateralrotation)– Rotation

Joint Ranges of MotionSide bending mustinduce rotationCervical spine– Motions occur in samedirectionsThoracic and Lumbarspine– Motions occur inopposite directions

Joint Ranges of MotionFlexion/Extension– limits side bendingand rotationThe abnormal jointmotion is the“OsteopathicLesion”

Osteopathic LesionDisturbance of Structure whichimpairs normal physiologicMotion and thereby interfereswith efficient Function

Somatic DysfunctionImpaired or altered function ofrelated components of the somaticsystem. (Body frame-work)– Skeleton, Joints and Myofascial structures– Vascular, Lymphatic and Neural elementsHospital Adaptation of the International Classification ofDisease, 2007. (ICD-9-CM CM 739.0-739.9)739.9)

Range of PassiveMotionMidline NeutralElastic BarrierParaphysiologic SpaceAnatomic Barrier

Range of Active MotionMotion loss due toMyofascial Shorteningmidline neutralPhysiologic BarrierElastic BarrierAnatomic Barrier

Minimal Motion LossActive MotionAvailable MotionLossPhysiologic BarrierMidlineneutralElastic BarrierAnatomic BarrierRestrictive Barrier

Conceptual SummaryThe body must move to maintain healthDecreased motion = DecreasedfunctionDecreased function = Increased painOsteopathic Manipulative Therapy– Restores Motion– Increases Function– Decreases Pain

Manipulation in AcuteLow Back PainReview of good quality large systematicreviewsStatistically significant shortening ofrecovery time occurred in manipulationgroup compared to ALL OTHER treatmentmethodsCochrane Review, 2004;(1): CD000447Spine J, 2004; 4:335-56.56.J Manip Phys Th, 2003;26: 593-601.Eur Spine J, 2006;15: s64-81.

Mechanical Low Back PainReview of good quality large controlledsystematic reviewsShort term pain scores significantly improvedwith manipulationPatients reported greater improvement in sittingand ADL’s s ( p < .01)Long term benefits were not seen (NS)Cochrane Review, 2004;(1): CD000447Spine J, 2004; 4:335-56.56.J Manip Phys Th, 2003;26: 593-601.

Sciatica Pain at 6 months102 subjects with acute low back pain andsciaticaCompared true manipulation to shammanipulationFollowed subjects for 6 monthsSignificant improvement with true spinalmanipulation (p < .05)Santilli, Beghi, Finucci.SpineJ, , 2006; 6: 131-7.

Attitudes Toward Manual Medicine,Implications for CMEManual medicine is a physical modality infrequentlyused in primary care clinicsStudy looked at Physician and Patient attitudestoward MM– 81% Physicians & 76% Patients, felt it was safe– 56% Physicians & 59% Patients, thought it should bemore available– 71% of Physicians desired CME trainingStoll ST, et.al, J Cont Educ Health Prof, , 2003;23(1):13-20

Well, Teach Me!We will learn directed diagnostic testsDirect and Indirect Techniques, such as:– Muscle energy– Counterstrain– Fascia release

10 Step Screening ExamStep 2: StandingPatientPosture, Observe from:– Back, , level of ears,shoulders, scapula,iliac crests & greatertrochanters

10 Step Screening ExamStep 2: StandingPatientPosture, Observe from:– Front, level of eyes,ears, shoulders & ilia

10 Step Screening ExamStep 2: StandingPatientPosture, Observe from:– Side, , line up ears,shoulders, greatertrochanter & lateralmalleolus

10 Step Screening ExamStep 3:StandingSpinalMotionLumbarsidebending– Note symmetryof wherefingers contactknee

10 Step Screening ExamStep 3: StandingSpinal MotionStanding Flexion Test– Note symmetry ofmotion of PSIS– Rotation of torso– Positive side is theone where the PSISmoves most

10 Step Screening ExamStep 5: SeatedFlexion TestNote symmetry ofmotion of PSISCompare results tostanding flexion test

10 Step Screening ExamStep 5: SeatedFlexion TestNote symmetry of motionof PSISCompare results tostanding flexion testPositive side is the onewhere the PSIS movesmost

Osteopathic TechniquesDirect– Move the joint through therestriction(directly restoring physiologicmotion).– High Velocity/Low Amplitude– Muscle Energy

Osteopathic TechniquesMuscle Energy– Place the joint at the restrictive barrier, thepatient actively moves away from therestriction, but meets light resistance(3 pounds) from the operator– Patient then relaxes and the operator gentlymoves the patient into the restrictive barrier– Repeat until motion is restored

Osteopathic TechniquesMuscle Energy– Region at restrictivebarrier,– Patient actively movesaway from the restriction,– Operator applies lightresistance (3 pounds)– Patient relaxes,– Operator gently movespatient into the restrictivebarrier– Repeat until motion isrestored

Apply this Technique to NeckMuscle Energy is a SAFE way to treatneck pain– Acute neck pain – Whiplash– Chronic neck pain – Pain in the Neck– Young and Healthy– Old and Osteoporotic

10 Step Screening ExamStep 6:CervicalRange ofMotionFlexion/Extension

10 Step Screening ExamStep 6:CervicalRangeofMotionRotation

10 Step Screening ExamStep 6:CervicalRange ofMotionSidebending

10 Step Screening ExamStep 6:CervicalRange ofMotionSupinePassiveFlexion/Extension

10 Step Screening ExamStep 6:CervicalRange ofMotionSupinePassiveRotation

Remember,Joint Ranges of MotionSidebending must induce rotationCervical spine– Motions occur in same directionsThoracic and Lumbar spine– Motions occur in opposite directions

Minimal Motion LossActive MotionAvailable MotionLossPhysiologic BarrierMidlineneutralElastic BarrierAnatomic BarrierRestrictive Barrier

Osteopathic TechniquesMuscle Energy– Region at restrictivebarrier,– Patient actively movesaway from the restriction,– Operator applies lightresistance (3 pounds)– Patient relaxes,– Operator gently movespatient into the restrictivebarrier– Repeat until motion isrestored

Osteopathic TechniquesDirect– Move the joint through the restriction(directly restoring physiologic motion).– High Velocity/Low Amplitude

10 Step Screening ExamStep 3: StandingSpinal MotionStanding FlexionTest– Note symmetry ofmotion of PSIS– Rotation of torso– POSITIVE side isthe one wherethe PSIS movesmost

10 Step Screening ExamStep 5: SeatedFlexion TestNote symmetry of motionof PSISCompare results tostanding flexion testPOSITIVE side is the onewhere the PSIS movesmost

Osteopathic TechniquesDirect (MuscleEnergy)– SI- Joint Pain (SacralTorsion)– Painful (+) side is theside that moves MOSTon tests– Position that sideDOWN

Osteopathic TechniquesMuscle Energy– Region at restrictivebarrier,– Patient actively movesaway from the restriction,– Operator applies lightresistance (3 pounds)– Patient relaxes,– Operator gently movespatient into the restrictivebarrier– Repeat until motion isrestored

Osteopathic TechniquesIndirect– Move the joint away from the restriction, holdin that position– The fascial layers then return to their neutralposition and physiologic motion is restored– Fascia Release & Counterstrain techniques

Fibromyalgia Pain ReliefAssociated with OMTRandomized trial with 4 treatment groups– OMT, OMT & Meds, Moist heat, Meds only– Outcomes:Standardized Pain scaleDepression scaleSelf Evaluation of ADL’s– Results: OMT & Meds most effective, OMT alone alsosignificantGambler RG, Shores JH, et. al. J Am Osteo Assoc2002:102:321-5

Osteopathic TechniquesIndirect (Strain/Counterstrain)– L. Jones, D.O.– Thumb palpatestender point– Move surroundingtissue until painresolves - Hold for90 seconds

Osteopathic TechniquesIndirect (Counterstrain(Counterstrain)– Thumb palpates tenderpoint– Move surrounding tissueuntil pain resolves - Holdfor 90 seconds– Gently return the patientback to neutral position– Goal is to completelyremove pain in targetedtissue

CPT codes for OMT98925 OMT of 1-212 Body Regions98926 OMT of 3-434 Body Regions98927 OMT of 5-656 Body Regions98928 OMT of 7-878 Body Regions98929 OMT of 9-109Body RegionsBody regions referred to are: Head, cervical,lumbar, sacral, pelvic, lower/upper extremities,rib cage and abdomenUse 25 modifier with E&M code

Further TrainingAmerican Academy of Osteopathy– 317-879879-1881– www.academyofosteopathy.orgAmerican Osteopathic Association– 800-621621-17731773 X 8252– www.aoa-net.org

SummaryKey Concepts behind OMT emphasizemotionManipulation includes direct and indirecttechniquesROM, Standing & Seated Flexion testshelp with diagnosisMany OMT techniques of the neck, upperback, lower back and sacrum are safe andeffective

Questions??My contact information.Troy Glaser, D.O.Resurrection Sports Medicine7447 W. Talcott Ave #182Chicago, IL 60631773-990990-7600 office303-549549-6947 cellEmail: troyaglaser@yahoo.com