1. Introduction to Osteopathic Manipulative Medicine (OMM) and Palpation Amy Vagedes OMSV Therese Obioha OMSV June 5, 2013 Original presentation by: P. Ackerman, T. Neely, K. Ritchey, July 9, 2009

2. Lecture Topics What is a D.O.? D.O. Education What is OMM? Six Clinical Considerations The Osteopathic Exam

3. Who is a D.O? We are certified physicians, with separate but equal rights as allopathic physicians (M.Ds) We have practice rights in all 50 states, and internationally (in New Zealand, China, Canada, Russia and more) Dr. Eland Teaches our techniques in Germany

4. International Practice Rights http://en.wikipedia.org/wiki/File:DOworld.PNG

5. The D.O. Education Focus on Anatomy, Physiology and the musculoskeletal system Integrative/ Whole Person Approach Our education 4 year professional degree 2 years classes: Lecture and Small group tracks (Tas CPC experience. Amy and Therese PCC experience) OMM Lab: 200 hours of hands-on education 2 Years of hospital based clinical training

6. The D.O. Education 4 Osteopathic Principles / Concepts: 1. The body is a unit 2. The body is capable of self-regulation, self-healing, and health maintenance. 3. Structure and function are reciprocally interrelated. 4. Rational treatment is based upon the preceding three principles.

7. What is OMM? Osteopathic Manipulative Medicine Using the hands as a diagnostic and treatment tool Training the students to be a consistent and reproducible practitioners A skill that takes time and practice, like listening for heart sounds or suturing Objective findings of bone, muscles, joints and their relationship to the rest of the body

8. What is OMM? Examples of what we feel with our hands: Bogginess Thickening Stringiness Ropiness Firmness (hardening) Increased / Decreased Temp Incr. / Decr. Moisture 3 of 4

9. Six Clinical Considerations 1. Fluid Congestion 2. Sympathetic Nervous System 3. Parasympathetic Nervous System 4. Pain Considerations 5. Biomechanical Concerns 6. Psychosocial Concerns

10. Six Clinical Considerations #1 Fluid Considerations: Venous Lymphatic accumulation of tissue fluid. inability of the drainage system to cope with excess fluid.

11. Six Clinical Considerations Lymphatics are the ‘Overflow system’ of the body. Local drainage or lack thereof is only one component in the equation of fluid build up. Key Principle: Key Principle: Any blockage along the pathway of excess fluid will inhibit its drainage. Clinically Oriented Anatomy, 5 th Ed., p.45

12. Six Clinical Considerations #2 Sympathetic Nervous System The afferents affect the cord level at which they enter, so there is influence on: Internal organs Musculoskeletal system Blood vessel constriction Clinically Oriented Anatomy, 5th Ed., p.63

13. Six Clinical Considerations “Hypersympathetic activity is a common factor in disease.” Irvin Korr, PhD. -one of the pre-eminent physiologists who has worked and performed research within the Osteopathic profession.

14. Parasympathetic Nervous System #3 Cranial Nerve X is a primary source for visceral innervation The sacral level is another important source. Clinically Oriented Anatomy, 5th Ed., p.65

15. Six Clinical Considerations #4 Pain Pathways Pain fibers follow the course of the mixed spinal nerves Local inflammation will prolong the pain fiber stimulation. Facilitation in the nervous system will amplify the experience of pain Clinically Oriented Anatomy, 5th Ed., p.56 1 of 2

16. Six Clinical Considerations #5 Biomechanical Concerns: All of these stuctures course through the myo- fascial (muscles & fascia) system. Disruption (torques, twist, strains) can cause sub- optimal function #6 Psychosocial Concerns: Psychosomatic relationship of pain Integrative approach

17. The Osteopathic Exam Key to any diagnostic test is Consistency & Reproducibility We teach a Protocol for musculoskeletal diagnosis This is the basis for the Screen, Scan, Segmental Definition Model We will teach this method in the next lecture/labs

18. The Osteopathic Exam – Musculoskeletal Diagnosis SCREEN (Level 1) General Impression Is there a problem? What regions exhibit a problem? SEGMENTAL DEFINITION (Level 3) Diagnostic Characteristics What? What are the specific characteristics of the identified segment(s)? SCAN (Level 2) Location Where? Which mobile segment(s) in an identified region is(are) involved?

19. Lecture Summary D.Os are full physicians with national and international practice rights Four Osteopathic Principles Osteopathic Manipulative Medicine Six Clinical Considerations The hand as a diagnostic tool Consistency & Reproducibility

20. Questions? Break- Next is Lab

21. Palpatory Lab Lab Expectations Professional Touch Dominant Eye Palpatory Skills Palpatory Exercises: Coins Layered Palpation- arm Motion Palpation- Spine

22. Lab Expectations Attire: Shorts, t-shirts or tank tops Please take off shoes No rings or hook earrings Leave Bags, books and other items in locker room Please replace stools & pillows under tables after lab

23. Professional Touch Be respectful Be mindful of your hands Be aware of your partners level of comfort Ask about any cultural or religious preferences

24. Dominant Eye Look at an object ie. The clock Make a triangle/circle with hands around the object Make sure you are focused on the object Alternate closing the left and right eyes; if the object moves that is your non-dominant eye

25. Palpatory Skills Ability to Detect Tissue Texture Abnormality Asymmetry of position Differences of movement Sense position in space Change in palpatory findings (improvement and worsening)

26. Palpatory Skills T.A.R.T.S.T.A.R. T Tenderness A Asymmetry R Range of Motion T Tissue Texture changes S Sensitivity T Tissue Texture A Asymmetry R Range of Motion

27. Palpatory Skills Examples Superficial/Deep Compressible/Rigid Warm/Cold Moist/Dry Painful/Pain free Local or or widespread Relaxed/Tense Hypertonic/Hypotonic

28. Palpatory Exercise- Coins Pass the Coins, please. Close your eyes. Using the pads of each of your fingers explore the contours of the coin. What is the shape, size? What denomination is the coin? Can you determine which is heads/tails?

29. Palpatory Exercise- Coins Place coin under sheet of paper Can you feel the coin? Can you feel it move If this is too easy, use more layers of paper OR Advanced: Place strand of hair under page in phone book. Can you feel it? Keep increasing pages for difficulty

30. Palpatory Exercise- Layered Palpation Use your own forearm. Use the finger pads of one hand to explore the characteristics of the opposite forearm. Skin Muscle Blood Vessels Bone Layers in between

31. Can you feel my PULSE Doc? Palpatory exercise: Palpate your partner’s radial pulse with two fingers (besides your thumb-anyone know why???) Appreciate the pulse Gently apply pressure until you no longer feel a pulse Now, gently release the pressure until you can appreciate the pulse once more.

32. Palpatory Exercise- Spine Partners Place your hands on middle of back Feel for Spinous Process Move about 2 cm laterally- you should feel the transverse processes Does one side feel more prominent than the other? Have partner do the following motions Flexion Extension Sidebending Rotation Do you feel change?

33. Switch Partners Questions???

34. If time-LET’S PLAY ?

35. Laboratory Summary Lab Expectations Professional Touch & Dominant Eye Palpation Skills Palpatory Exercises Practice !! Next Lecture: The Osteopathic Exam: Screen, Scan and Segmental Definition

36. Thank-you ANY Questions? OMM Fellows Fellowso@oucom.ohiou.edu