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Somatic Dysfunction in Osteopathic Family Medicine

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Presentation on theme: "Somatic Dysfunction in Osteopathic Family Medicine"— Presentation transcript:

1 Somatic Dysfunction in Osteopathic Family Medicine

2 THe patient with Lower Respiratory Tract Infection
Chapter 17 THe patient with Lower Respiratory Tract Infection

3 From: Somatic Dysfunction in Osteopathic Family Medicine
From: Somatic Dysfunction in Osteopathic Family Medicine. Nelson KE, Glonek T, eds. Baltimore, MD: Lippincott, Williams & Wilkins; This presentation is intended to augment the didactic presentation of Chapter 17: The Patient with a Lower Respiratory Tract Infection, by Zachary J. Comeaux, DO. Produced by the Department of Osteopathic Manipulative Medicine, CCOM/MWU, Kurt Heinking DO, FAAO (Chair). Developed by: Samuel Yoakum, OMM fellow. Edited by the ACOFP subcommittee for OMM-OPP Publication and Educational Materials, Kenneth E. Nelson DO, FAAO, FACOFP (Chair) © American College of Osteopathic Family Physicians

4 Introduction Clearly antibiotics have become the mainstay for reducing morbidity due to pulmonary infections. Supportive care, however, can still play a significant role in recovery. Manipulative treatment is often seen as an alternative to pharmaceuticals, but both are more likely to be effective as complementary treatments.

5 Pneumonia Although this disease process may be the result of any of a wide spectrum of pathogens… the primary agent, for community acquired pneumonia (CAP), is still Streptococcus pneumoniae. This chapter mostly addresses the treatment of patients with uncomplicated cases of CAP.

6 Respiratory Function The lungs are usually viewed as organs of O2 exchange, driven by their ability to expand and contract with pressure changes. They also play a large role in the circulatory system, assisting both venous return and lymphatic drainage. Circulatory issues are as important as oxygenation in function and dysfunction of the respiratory system.

7 Osteopathic Correlations in Pneumonia
Classical Considerations: Still saw the problem as one of vascular stasis to be solved primarily by rib raising.1 Charles Hazzard describes a more general treatment beginning with cervicals and moving on to scalenes, ribs, segments and abdominal release.2 McConnell preferred regional treatment with attention to the thoracoabdominal diaphragm.3

8 Osteopathic Correlations in Pneumonia
Contemporary Considerations: Kuchera and Kuchera recommend a staged application of OMT to complement conventional medical care aimed at maximizing comfort and the individual’s ability to self-heal.4 Rib raising with paraspinal muscle stretching. Segmental treatments and myofascial release of accessory respiratory muscle fascias. Continued rib raising and segmental treatment with addition of lymphatic pump.

9 Treatment: Mechanisms of Action
Neuroreflexive: Sympathetic – hypertonicity leads to tachypnea, tachycardia and vasoconstriction. Proximity of sympathetic chain ganglia to rib heads allows for external inhibition of this hypertonicity. Facilitation – segmental dysfunction can lead to viscero-somatic or somato-visceral reflexes.

10 Treatment: Mechanisms of Action
Biomechanical: Articular – the costovertebral contacts and intervertebral facet joints must have full mobility for full lung expansion to occur. Myofascial – For optimal respiration distensibility of the horizontal diaphragms; tentorium cerebellae, thoracic inlet, throracoabdominal, pelvic floor and the fascial elements of the accessory muscles of respiration is essential.

11 Treatment: Mechanisms of Action
Vascular : Lymphatic – primary lymph drainage from the lower body is to the left subclavian vein, dependent primarily upon respiration pressure gradients. Venous – much venous return relies on activities of daily living, which illness suspends. Interstitial – tissue edema must be cleared through the vascular system. External pressure may assist in this process.

12 Diagnosis Specific diagnosis of somatic dysfunction is mandatory for effective OMT. Begin with a global assessment of the thoracic region. Assess for rib and spinal segmental restrictions. Assess other regional influences, including the throracoabdominal diaphragm and pelvic floor.

13 Treatment Considerations
Possible Interventions: Rib raising. Rib articulation. Paraspinal muscle stretch. Lymphatic pump. Occipitoatlantal release. Cervical paraspinal muscle release. Cervical articulatory release. Diaphragmatic release. Oscillatory Release.

14 Treatment Considerations
Rib Raising: can be accomplished in several positions. fingertips are used as a fulcrum. treat all ribs. increased restriction requires increased focus. Rib Articulation: performed seated. combines translation/sidebending and rotation. gentle, rhythmic and repetitive. a good alternative to HVLA treatments.

15 Treatment Considerations
Paraspinal Muscle Stretch: performed with the patient in the lateral-recumbent. a simple but effective soft tissue procedure. Lymphatic Pump: pedal pump is excellent for the hospital setting. Thoracic pump is more specific for the lungs. Occipitoatlantal Release: normalizes tensions surrounding the vagus. is a relatively quick technique (one - two minutes).

16 Treatment Considerations
Cervical Paraspinal Muscle Release: relaxes accessory muscles of respiration. maximizes phrenic nerve function. excellent for hospital setting. Cervical Articulatory Release: treat dysfunction of the C3-C5 segments to affect the phrenic nerve. performed with patient seated. may add oscillation to enhance the procedure.

17 Treatment Considerations
Diaphragmatic Release: generally performed with patient supine. may use direct or indirect approach. performed in all three planes. highly effective.


19 References Still AT. Research and Practice. Kirksville, MO: Author, Reprinted in Seattle: Eastland Press, 1992;83-89 Hazzard C. Pneumonia. In: The Practice of Applied Therapeutics of Osteopathy Jordan T, Schuster R, eds. Selected Writings of Carl Philip McConnell, DO. Columbus, OH: Squirrel’s Tail, 1994;90. Kuchera M, Kuchera W. Osteopathic Considerations in Systemic Dysfunction. 2nd ed. Columbus, OH: Greyden, 1994;45.

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