OMT for Healthy Aging Menopause and Beyond - CECity

Muscle energy or indirect techniques tothe lumbosacral spine could be performedwhile the patient is sitting or standing.Patient positioning for treatment maydepend upon placing her in a comfortableposition or using her weight, respiratoryeffort and posture as adjunctive measures.Such a patient may have a large bodyhabitus that challenges the physician toperform a treatment procedure in a recumbentposition. Or the patient may not beable to breathe lying supine.After somatic dysfunctions of the pelvishave been identified and addressed, otherpain or gait problems may be reportedby the patient. While examining the lowerextremities for cyanosis, edema, and varicosities,the physician can observe gait.Painful gait may be result of plantarfasciitis, flat feet, or somatic dysfunction asevidenced by identification of counterstraintender points on feet, ankles, and knees.Posterior fibular head dysfunction aswell as inflammatory arthritis may contributeto genu valgus. Addressing gravitationalstrains and muscle imbalances beforereferring the patient for orthotic devicesmight relieve pain and save money frompurchasing shoes that may be neitherhelpful nor comfortable.Evaluation of the thoracic spine and ribcage may reveal viscerosomatic dysfunction.Compression fractures are commonaround the level of the 8th or 9th thoracicsegments. Digestive complaints such asreflux, hiatal hernia, or eructation may correlatewith joint restriction in the mid tolower thoracic spine.Inability to take deep breaths may bedue to restricted motion of the thorax andclavicles. This affects posture and upperback pain. Compromised motion of upperribs and thoracic spine may cause edema inthe neck and upper extremities.Menopausal women often have shoulderpain that may be due to arthritisthat was aggravated by lifting suchheavy items as groceries or grandchildren.Gentle range of motion techniques ormyofascial stretching may retard shoulderimpingement. Trigger points may uncoverfibromyalgia or areas of referred painof which the cause of upper extremitypain is not limited to the extremity itself.Complaints suggesting carpal tunnelsyndrome may be the result of somatic dysfunctionof interosseous membrane of theforearm or of the cervical spine. Structuralevaluation of the cervical spine andnotation of range of motion help assessthe patient’s ability to turn her head andneck in order to perform such simple tasksas backing her auto out of the garageor parking space. Severe arthritis withbone spurring or limited range of motionshould preclude performance of anytreatment technique that may place thecervical spine in a position of hyper-extensionor hyper-rotation to avoid vertebralartery injury or stroke.Headaches due to muscle contractionwith vascular congestion or increased cervicallordosis may be relieved with treatmentof the occipital-atlantal junction justbeneath the skull. Increased range of motionof this area may also be the result ofmuscle relaxation. While the patient’s headand neck are being treated, she may bephysically relaxed enough to discuss psychologicalor emotional stressors whichmay also require her physician’s assistance.Opportunities to incorporate osteopathicmanipulative treatment in healthmanagement plans for menopausal womenwho desire to age gracefully have been discussed.Osteopathic physicians can updatetheir skills and techniques by attendingcourses offered by state associations, osteopathiccollege post-graduate programming,college of osteopathic family practice, orthe American Academy of Osteopathy.Osteopathic physicians who focus theirpractice on neuromusculoskeletal medicineand manipulative medicine can providemore in-depth evaluation and treatment ofstructural problems referred to them bycolleagues or other patients. ❙ wwReference1. Ward, R. ed. Foundations for OsteopathicMedicine, 2nd ed. 2002. Lippincott,Williams & Wilkins, Philadelphia, Pa.Melicien A. Tettambel, DO, is a fellow of theAmerican Academy of Osteopathy and theAmerican College of Osteopathic Obstetriciansand Gynecologists.20