1. Introduction to Osteopathic Medicine Ronald Januchowski, D.O. Associate Dean, VCOM

2. Objectives Review the history of Osteopathic Medicine Introduce / review some common techniques Practical applications

3. History of Osteopathic Medicine Some dates 1874 – basic principles first articulated by A.T. Still, M.D. 1892 – first college founded in Kirksville, Missouri 1950 – start of full practice rights 1967 – draft extends to D.O. 1973 – full practice rights in all 50 states

4. History of Osteopathic Medicine Basic tenets of Osteopathic Medicine The body is a unit, and the person represents a combination of body, mind, and spirit.personbodymindspirit The body is capable of self-regulation, self-healing, and health maintenance.self-regulation Structure and function are reciprocally interrelated. Rational treatment is based on an understanding of these principles: body unity, self-regulation, and the interrelationship of structure and function

5. History of Osteopathic Medicine Evolution of mission and identity YearIdentity or mission 1892-1950Manual Medicine 1951-1972Family Practice / manual therapy 1973 – presentFull service, multispecialty care

6. History of Osteopathic Medicine – Growth FIRST YEAR ENROLLEMENT IN D.O. SCHOOLS

7. History of Osteopathic Medicine – Growth Medical schools in the U.S. 34 D.O. schools 137 M.D. schools

8. History of Osteopathic Medicine – % by state Location of osteopathic medicine schools are shown in red % of physicians in state <3% 3-5% 5-10% 10-15% 15-25%

9. History of Osteopathic Medicine D.O. vs. M.D.’s D.O. 4 years of medical school Residency training Licensing exam Unlimited medical practice Use of Osteopathic Manipulative Treatments in addition to medicines and/or surgery M.D. 4 years of medical school Residency training Licensing exam Unlimited medical practice Use of medicines and/or surgery

10. History of Osteopathic Medicine D.O. vs. Chiropractors D.O. 4 years of medical school Manipulation as one method of many treatment methods Fully licensed, unlimited practice physicians Chiropractic Medicine 4 years of chiropractic school Use of spinal adjustment is main method of treatment Limited practice licensure

11. Terminology - Diagnosis Somatic dysfunction Impaired function of the body framework Treatable using OMT Described using Position of the part Direction which motion is best or limited TART

12. Terminology - Treatment Soft tissue techniques Effluerage / lymphatic techniques Counterstrain Muscle Energy HVLA

13. Terminology – Treatment Soft tissue stretching Lengthening linear/band muscles Gentle technique Can be performed on acute injuries

14. Terminology - Treatment Effleurage Gentle technique Improves lymphatic flow Reduces sympathetic tone to the area Lymphatic pump Generally gentle Improves lymphatic flow

15. Terminology – Treatment Counterstrain Gentle technique Find a dysfunction and place the area in a position of comfort Hold for 90 seconds and return to neutral position

16. Terminology - Treatment Muscle Energy Take dysfunction to barrier Resist movement away from barrier Repeat Works for small or large areas Gentle technique

17. Terminology - Treatment High Velocity Low Amplitude (HVLA) Takes an area of dysfunction to a barrier Thrusting through the functional barrier to improve movement

18. Headaches in History

20. Headache Types Primary Migraine (with and without aura) headache Tension-type headache Cluster headache Secondary Sinus related Vascular (AVM, aneurysm) Post trauma Structural or metabolic derangements

21. Exam findings Structural exam findings C1-C3 somatic dysfunction Tender points in particular headaches Frontal & orbital (C1, occipitomastoid) Periorbital (C2, occipitomastoid, infraorbital and nasal) Occipital (C4) Motion restrictions in OA area Scapular / upper thoracic dysfunction Sacral dysfunction sometime involved

22. Acute Treatment Plan Treat rapidly Restore patient’s function Optimize self-care Minimize side effects

23. Acute Treatment – TTH Aspirin Acetominophen NSAIDs Ibuprofen, Ketoprofen, Naproxen Ketorolac Combinations with caffeine Excedrin Migraine, Advil Migraine

24. Acute Treatment – TTH Butalbital or codeine combos Not recommended for general patients because of side effects and/or overuse May be used in patients who cannot use to other meds (pregnancy, renal failure) Triptans, Muscle relaxants Not effective in pure TTH Other methods OMT Ice, biofeedback

25. Preventive Treatment – TTH Amitriptyline SNRIs Mirtazipine Venlafaxine SSRIs – no benefit over placebo Anticonvulsants – limited data Gabapentin Topiramate

26. Preventive Treatment – TTH Tizantidine – limited studies Botulinum toxin – no effect over placebo Behavioral therapy – limited studies Physical modalities Spinal manipulation / OMT was less effective than Amitriptyline for initial pain, but had better lasting effect and less side effects Craniocervical exercises effective

27. Osteopathic techniques for headache treatment Soft tissue techniques OA / Cervical Spine / rhomboids Counterstrain OA / Cervical Muscle Energy Scalenes HVLA Lumbar roll

28. Questions?