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Goal Biomechanical model
goal to improve ROM, muscle tightness, joint function, and decrease pain
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Goal neurological model
- decrease nerve impingement/irritation, lessen pain, improve function to innervated structure
- ex. carpal tunnal, neuropathy. migraines
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Goal Respiratory/Circulatory model
- Improve respiraroty excursion, ciculation of blood and lymph anf enhacne immune function
- ex. pneumonia. cellulitis, edems, vacular disease, and upper respiratory issues like flu and sinuses
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Goal psychobehavioral model
- reduce stress, decrease muscles tension, enhance well being, promote physical activity
- ex. anxiety, depression, chronic pain, insomnia, and stress
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The bio energetic metabolic model
- enhance tissue/organ physiology, promote tissue repair, reduce ebergy expenditure
- ex fibromyalgia, concussion, severe osteoarthritis
- * these overlap with other models.
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What techniques could be applied to muscles that suffer from cold?
Muscles energy of AA joint and myo fascial perpendicular stretch of the trapezius
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what are level B evidences of the effectiveness of OMT
- ACute & Chronic LBP
- POst operative pain control
- Pain in the spinal cord injury
- Pneumonia
- Pediatric otitis media
- Premature infant NICU
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Types of OMT techniques
- Myofascial technique
- Muscle energy
- HVLA
- Facilitate positional technique
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OMT prescription outline
- diagnosis
- Target
- Selection treatment
- Administration
- Instruction and follow up
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What determine when you treat with OMT
It is based on the clinical diagnosis, clinical setting, and clinical goals.
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what are the general guidelines for chronic, less sever or outpatients?
- range of forces, direction, passive vs. active, duration .
- short to long duration
- less frequency
- and limited time period if acute and longer if chronic
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what are the general guidelines for acute, sever or inpatients?
- gentle
- passive
- indirect
- short duration
- greatr frequency
- limited period of treatment ( days to weeks)
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what are side effect of OMT ?
- Typically mild, temporary, and results in no harm
- ex:
- soreness
- fatigue
- reaggreviation
- flare-up of symptoms
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Way to prevent side effects of OMT
- tell patients to:
- stay hydrated
- modify activity
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what are absolute contraindication of OMT?
- down syndrome
- unclear diagnosis
- physician doubt
- fracture, infection, blood clot, or cancer
- Osteporosis
- Patient noncooperation, intolerance, or discomfort
- no somatic dysfunction
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inpatient menaing
a patient stays in the hospital while under treatment
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A 25-year-old female patient is hospitalized for a severe migraine headache. On
examination, you detect significant muscle hypertonicity and tenderness in her
upper cervical paraspinal muscles.
- A. Is OMT indicated?
- Yes
- B. What osteopathic care model?
- Neurological
- C. Direct vs Indirect
- Indirect because she is "severe and hospitalized" (inpatient)
- D. Active vs Passive
- Passive because pt.is not in a state to help you
- E. Duration and frequency
- short duration and great frequency
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A 45-year-old male patient is seen in the office for acute left calf swelling and
pain. He is a smoker. On examination, you detect a limp in the left leg as he walks.
His left calf feels unusually warm, firm, and tender. You consider the role of OMT
in this patient.
- A. Is OMT indicated?
- NO! because the symptoms say blood clot
- B. What osteopathic care model?
- C. Direct vs Indirect
- D. Active vs Passive
- E. Duration and frequency
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A 65-year-old male patient is seen in the office for chronic heartburn. He is
requesting a refill on his omeprazole (acid blocker). On examination, you note
that his lower ribcage doesn’t move well, and his upper lumbar paraspinal region
feels ropy with dry skin texture.
- A. Is OMT indicated?
- yes gerd is an indication
- B. What osteopathic care model?
- Neurological because an organ ( viscera) since the sypathethic nerouse system has influences on all organs, viscerosomatic influences and somatic visceral influences (dysfunction in the spine can affect the stomach)
- and you can thinf of the enteric nervous system for gerd or biomechanical because of the muscle and movement of the rib cage . the crus ( lumbar segments) that come off the diapmra
- C. Direct vs Indirect
- either
- D. Active vs Passive
- either
- E. Duration and frequency
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what is the crus
- it is on the underside of the diaphragm
- This structure surrounds the esophagus. It controls the opening and the closing of the gastroesophogeal junction
- so if there is dysfunction of this crus area along with upper lumbar spine this can effect stomach
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what is the mnemonic for how you can incorporate the osteopathic thinking process into clinical decision making ?
- D I G M O R E
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