Saturday, January 28, 2006

Cervicalgia and Osteopathic Manipulative Treatment

Source: displayarticle.php/article1833.html

Can you tell me what cervicalgia is as my physician has told me that this is what I am suffering from and it should go away in time with Osteopathic Manipulative Treatment?

Cervicalgia is a medical term meaning 'pain in the neck'. This can arise due to any incident that involves sudden movement of the neck, and in many cases no particular event is remembered. The nerve roots that arise from the spinal cord in the neck can be affected by sudden stretching or compression, and pain and spasm in the muscles of the neck tend to occur as a result. Usually neck movements are painful and restricted, and the pain may radiate to the shoulder region.

Symptoms of cervicalgia include:A sharp pain in the neck. Aching in the neck. Pain when turning the head sideways.

The treatment of cervicalgia includes local heat treatment, pain-killers, rest, muscle relaxants and physiotherapy. In most cases symptoms will settle within a few weeks, but sometimes they can be prolonged. Lifestyle factors such as position of work (especially for people using VDUs), posture, and type of bed, can all play a part in prolonging this condition.

Osteopathic Manipulative Treatment, as well as providing local treatments, usually includes advice about lifestyle factors, and exercises to protect and strengthen the spine.

What can the person do about cervicalgia?

Apply ice if a tear in the muscle is suspected.
Wear a special neck collar to help the muscles rest.
See a sports injury professional who can advise on rehabilitation.
Look at possible causes of injury.

What can a physician specialist in physical medicine and rehabilitation do?

Advise on a full rehabilitation programme of stretching, strengthening and sports massage techniques.
Prescribe muscle relaxing medication.
Apply traction and use Osteopathic Manipulative Treatment.

Osteopathic Manipulative Treatment and Scoliosis treatment

Source: Scoliosis treatment using spinal manipulation and the Pettibon Weighting SystemTM: a summary of 3 atypical presentations
Mark W Morningstar and Timothy Joy
Chiropractic & Osteopathy 2006, 14:1 doi:10.1186/1746-1340-14-1

Published 12 January 2006

Abstract (provisional)


Given the relative lack of treatment options for mild to moderate scoliosis, when the Cobb angle measurements fall below the 25-30o range, conservative manual therapies for scoliosis treatment have been increasingly investigated in recent years. In this case series, we present 3 specific cases of scoliosis.

Case presentation

Patient presentation, examination, intervention and outcomes are detailed for each case. The types of scoliosis presented here are left thoracic, idiopathic scoliosis after Harrington rod instrumentation, and a left thoracic scoliosis secondary to Scheuermann's Kyphosis. Each case carries its own clinical significance, in relation to clinical presentation. The first patient presented for chiropractic treatment with a 35degrees thoracic dextroscoliosis 18 years following Harrington Rod instrumentation and fusion. The second patient presented with a 22degrees thoracic levoscoliosis and concomitant Scheuermann's Disease. Finally, the third case summarizes the treatment of a patient with a primary 37degrees idiopathic thoracic levoscoliosis. Each patient was treated with a novel active rehabilitation program for varying lengths of time, including spinal manipulation and a patented external head and body weighting system. Following a course of treatment, consisting of clinic and home care treatments, post-treatment x-rays and examinations were conducted. Improvement in symptoms and daily function was obtained in all 3 cases. Concerning Cobb angle measurements, there was an apparent reduction in Cobb angle of 13o, 8o, and 16o over a maximum of 12 weeks of treatment.


Although mild to moderate reductions in Cobb angle measurements were achieved in these cases, these improvements may not be related to the symptomatic and functional improvements. The lack of a control also includes the possibility of a placebo effect. However, this study adds to the growing body of literature investigating methods by which mild to moderate cases of scoliosis can be treated conservatively. Further investigation is necessary to determine whether curve reduction and/or manipulation and/or placebo was responsible for the symptomatic and functional improvements noted in these cases.

Osteopathic Manipulation In Operation Iraqi Freedom


Christopher Prior, DO

Christopher Milstead, FNP

Back pain, a common problem in primary care, can lead to medical evacuation and termination of a mission.1 Even in the most austere conditions early identification and treatment increases the soldiers’ ability to return to his or her unit. Early treatment, education, and utilization of available resources can keep a soldier in the theater of operations—increasing morale and success of the mission.

The admitting diagnosis for 25 percent of the soldiers admitted to the 115th Field Hospital in Kuwait during Operation Enduring Freedom and Operation Iraqi Freedom was back pain. Common causes included motor/mechanized vehicle accidents, falls, and shrapnel injuries. Many soldiers required evacuation to rear echelons of care for more advanced radiological studies, including CT and MRI. Many soldiers were immobilized through out the multi tiered evacuation process sometimes lasting 48-72 hours. While conservative measures are expected in the most forward care settings, many soldiers could have been re-evaluated and treated sooner. In many circumstances the prolonged immobilization hindered prompt recovery. Early evaluation and treatment enables soldiers with back pain to return to duty sooner—seventy five percent of those soldiers that returned to duty were evaluated within 48 hours of their injury. Those soldiers who were immobilized for extended periods of time naturally took a longer time to recover. Soldiers with fractures and radicular signs were quickly identified and evacuated to the most rear facilities for extended treatment which sometimes lasted up to 2 weeks.

In the outpatient setting at the Arifjan Troop Medical Clinic, back pain only accounted for approximately 5 percent of sick call visits. Most of these soldiers returned to duty if not immediately, usually within 48 hours. These soldiers had multiple modalities of manual medicine available daily and could return to duty with slight modifications in workload. The predominate cause of back injuries at the Troop Medical Clinic was lifting injuries. Some injuries could have been prevented with proper lifting techniques and precautions. Unfortunately “Back School” was not readily available for all units beforehand.

Possible causes of increased rates of back pain include altered work rest cycles, poor sleep patterns, poor sleep conditions, and combat stress. One of the more common causes was the increased load of personal protective equipment worn during operational activities. This can be corrected by training with protective equipment or the redesign of the personal equipment carrier, perhaps similar to the British Armed Forces load bearing back-pack. In some situations the rest-work cycles and sleep cycles can not be altered for obvious reasons. Primary care providers, physical therapists, psychologists and psychiatrists were readily available to identify possible victims of combat stress. Behavioral health counselors were immediately incorporated into management plans to assist soldiers at risk for combat stress.

Treatment options include osteopathic manipulation, physical therapy techniques including traction and transcutaneous electrical nerve stimulator (TENS) unit, moist heat, ice, anti inflammatory medications, muscle relaxants, and steroid injections. Even in the most austere environments osteopathic manipulation, TENS, traction, stretching exercises, and pain medicines were readily available.

Some barriers to treatment included delayed triage, prolonged immobilization, combat stress, and poor advice early in the treatment plan. Most patients whose triage was delayed or who were immobilized for prolonged periods felt that their pain was not being addressed. This decreased their trust in the delivery and quality of health care they received and sometimes delayed their eventual recovery. Unfortunately, if a soldier was advised they would be medically evacuated out of the theater of operation it was extremely difficult to change this patients’ lack of motivation for a timely recovery and usually resulted in their medical evacuation.
In the traditional primary care setting, back pain is one of the most costly ailments because of days missed from work. In support of Operation Enduring Freedom and Operation Iraqi Freedom back pain not only decreases morale and efficiency of a unit, but it also puts individuals and units at greater risk of failure of a mission and potential loss of soldiers. Even in the most austere conditions, we found osteopathic manipulation and physical therapy increased efficiency and improved morale and the ability to accomplish the mission. Additionally we found that the back pain patients treated with osteopathic manipulation and physical therapy had the greatest understanding of their medical conditions and treatment plans as opposed to other medical or surgical admissions.

1. Hart LG, Deyo RA, Cherkin DC. Physician office visits for low back pain. Frequency, clinical evaluation, and treatment patterns from a US national Survey. Spin 1995; 20:11-9.

The opinions and assertions contained herein are the private views of the author and are not to be construed as views as official or as reflecting the views of the US Army Medical Department of the US Army Service at large.



The way you stand, sit and move, reach over and pick up or carry objects all affect the well being of the back. Here are some tips for helping prevent back injury.


Lift wisely
Always bend your knees when lifting heavy objects. The large muscles in your thighs and buttocks are far better equipped to bear heavy loads than the smaller muscles of your back.

Carry objects close to your body
Holding heavy objects (such as a large vase of flowers) away from the body is inviting back injury. Make sure that you hold heavy objects close to your torso when lifting. Twisting your body while pulling or lifting is a primary cause of back injury. Always keep your body straight when carrying, pulling, or reaching for an object.

Watch your golf swing
The twisting motion employed by golfers often leads to back injury. The invertebral disks (the cartilagenous shock absorbers that separate the bones of the spine) are injury-prone zones for golfers. The disk is most vulnerable when the back is extended or arched, and the body is rotated. With an improper or overly-strenuous swing, the covering of the disk unwinds and tears.
Warming up and stretching before golfing will help you avoid disk injury. When swinging your club, do so gently, trying to keep your shoulders and chest centered over your pelvis.

Be careful exiting cars
When exiting a car, turn your whole body to the side. Place both feet on the ground and stand up carefully. Reverse the procedure when entering a car. First, sit down, then swing both legs in together so that you do not twist your back.

Sit properly
The human spine as not designed to maintain a sitting position for long periods of time. Driving, working at your desk, spending time on a plane, sitting at the computer, and watching sports are all activities that can lead to back pain. The best way to avoid back strain is to get up every fifteen minutes or so and walk around. (If you are driving, pull over whenever convenient to stretch your legs.)
If you sit for long periods at work, invest in a well-designed chair that supports your back and allows you to change positions easily. A cushion tucked behind your back while driving will help provide support and comfort.

Stay fit
Exercising regularly will help you avoid the strains and stresses associated with weakened back muscles. Swimming, low-impact aerobics and walking will help tighten the muscles of the back and abdomen. Local recreation centers and other fitness organizations usually run exercise programs specially designed for people wishing to control back pain.

Cope with stress
Research shows that people who respond to stress by becoming anxious are far more likely to develop stress-related physical symptoms such as back pain. If you are prone to anxiety, explore the many techniques to help you manage stress effectively. Your doctor, library, and the Internet are good sources of information.

Living a sedentary lifestyle, being in an occupation (or having a hobby) that requires lifting, bending and/or twisting, and mismanaging stress are all risk factors for back problems. People who sit for long periods also run the risk of straining the back when rising or moving from a seated position.

Warehouse workers, long-distance drivers, cyclists (whether recreational or occupational), golfers, computer operators, nurses and gardeners/groundspeople all have more incidence of lower back disorders than the general population. Smokers are at higher risk for back problems, perhaps because smoking decreases blood circulation. This could however be due to an unhealthy lifestyle in general.



In about 85% of back pain cases, the origin of the pain is unknown and even imaging studies usually fail to determine the cause.

Herniated Disc and Other Disc Abnormalities

Disc herniation and disc degeneration due to aging are the most common causes of low back pain. Other problems can also cause this pain, however.

Lumbar Degenerative Disc Disease. Over the years, the disc can degenerate and produce low-grade inflammation and irritation. This age-related condition is the major source of chronic low back pain.

Herniated Disc. A herniated disc, sometimes, but incorrectly, called a slipped disc, is widely held to be the most common cause of severe back pain and sciatica. A disc in the lumbar area becomes herniated when it ruptures or thins out and degenerates to the point that the gelatin within the disc protrudes outward.

It is commonly believed that that low back pain most often occurs if this material extrudes (that is, it balloons into the area outside the vertebrae or breaks off from the disc) far enough out to press against the nerve root, most often the sciatic nerve. Recently, however, researchers are finding that the presence of such a pinched nerve does not necessarily relate to the severity of the pain. In fact, as people age, disc bulging and protrusion are very common occurrences, and in most cases do not cause any back pain. And, sciatica pain is sometimes present when there is no bulging or extruding of the discs. Experts increasingly believe, then, that low back pain associated with disc abnormalities may result from factors other then compressed nerves.

The Annular Ring. Increasingly, research is focusing on tears in the annular ring, which is the fibrous band that surrounds and protects the disc. The annular ring contains a dense nerve network and high levels of peptides that heighten perception of pain:
Tears in the annular ring are a frequent finding in patients with degenerative disk disease.

Some cases of chronic low back pain may be caused by inward growth of nerve fibers into the annular ring, which trigger pain within the intervertebral.

Muscle and Ligament Injuries
Other than age-related degenerative disk disorders injuries in the muscles and ligaments supporting the back are the major causes of low back pain.

Spinal Stenosis
Spinal stenosis is the narrowing of the spinal canal. This typically develops as a person ages and the discs become drier and start to shrink. At some point in this process, any disruption, such as a minor injury that results in disc inflammation, can cause impingement on the nerve root and trigger pain. Pain from spinal stenosis can occur in both legs or can cause sciatic pain. Spinal stenosis occurs mostly in the elderly with degenerative osteoarthritis, but it can sometimes be caused by other problems, including infection and birth defects.

Miscellaneous Abnormalities

A number of conditions that affect the joints, vertebrae, or nerve roots can cause back pain:
Spondylolisthesis is a condition in which one vertebra has slipped forward over the other. This is also a cause of sciatica.

The facet joints can wear down. In such cases, pain occurs on arching the back or when walking.

In some cases a segment (consisting of two vertebra and their common joint and disc) becomes unstable when its parts wear down.

Some patients may have scar tissue that traps the nerve roots in the lower spine and causes sciatica.

Piriformis Syndrome
Some experts believe that one cause of sciatica pain is the entrapment of the sciatic nerve deep in the buttock by the piriformis muscle. It usually develops after an injury. Others believe there is no real evidence that this condition, known as piriformis syndrome, causes any sciatic pain.

Osteopathic Manipulative Treatment in Action

Family Health Radio Series

Enhancing the flow of lymph with OMT

FIRST AID FOR NECK PAIN :Reducing Neck Pain.


Stop any exercise or treatment that increases your pain. When you first feel a catch or strain in you neck, try these steps to avoid or reduce expected pain. These are the most important home treatments for the first few days of neck pain.

First aid # 1
As soon as possible, apply an ice pack to the injured area. (10-15 minutes every hour). Cold limits swelling, reduces pain and speeds healing.

First aid # 2
Some medications are available without a prescription. If the non-prescription dose does not relieve your pain CALL YOUR DOCTOR. Take aspirin or ibuprofen reglularly as directed on the bottle(call your doctor if you've been told to avoid anti inflammatory medication). Acetaminophen (tylenol) may also be used. Take these medications sensibly; never exceed the dosage suggested on the bottle, the maximum recommended dose will reduce the pain. Masking the pain completely might allow movement that could lead to re-injury.

First aid # 3
Take the time to add a small pillow or towel roll to support your head/neck when you are sitting or lying down. DON'T STAY IN ANY POSITION THAT INCREASES YOUR PAIN.

First aid # 4
RELAX YOUR MUSCLES Listen to soft music - Practice deep breathing - try one of the commercially available relaxation tapes.

First aid # 5
USE A COLLAR USE A COLLAR A soft collar can help to rest your neck. This should be used for short periods .(Not more than an hour at a time. - take it off after the first fifteen minutes to be sure it does not increase your pain - Not more than a few days.)

First aid # 6


Sit or stand in a comfortable position
Move your head slightly to one side, bringing your ear closer to your shoulder
Keep your shoulders down
Relax and hold for 5-10 seconds
Stop if pain is increased or has moved into the arm or toward the hand.
click here for picture

Sit or stand in a comfortable position
Pinch your shoulder blades together
Bring your chin back so it is in line with your shoulder and hip(see picture)
Keep eyes level - do not look up or down
This is a very small movement of your head, do not push back too hard.
Keep your shoulders down
Relax and hold for 5-20 seconds
Stop if pain is increased or has moved into the arm or toward the hand.
click here for picture

Sit or stand in a comfortable position
Turns your head slowly to one side.
Keep your shoulders down.
Relax and hold for 5-10 seconds.
Stop if pain is increased or has moved into the arm or toward the hand.
click here for picture
Do the first aid exercises three to four times a day .
After two or three days of home treatment:

Slowly increase the frequency of the first aid exercises. When your pain is gone slowly resume normal activities. Continue to use caution with lifting, bending, sitting & sports for 6 - 8 weeks, after the pain is gone, to allow the neck to heal. If you have a regular exercise program begin easy exercises that do not increase your pain. Start with 2-5 repetitions twice a day and increase to 10 as you are able.

Osteopathic Manipulative Treatment and Severe Neck Pain


Your spine is made up of bones (vertebrae that support the body's weight), their joints (facets that guide the direction of the movement of the spine), and the discs (which separate the vertebrae and absorb the shock as you move), the muscles and the ligaments that hold it all together. One or more of these structures can be injured:

You can strain or sprain the ligaments or muscles from a sudden movement, improper movement, or through over use.

You can damage your discs in the same way so that they tear or stretch. If the tear is large enough, it may press against a nerve. The nerve may also become irritated due to swelling or inflammation of the other parts of the neck.

Any of these injuries can result in a two-or-three day period of acute pain and swelling in the injured tissue, followed by slow healing and gradual reduction of pain. The pain may be felt in the neck, the head(headaches), in the shoulder, or down arm(often the pain is felt primarily in the shoulder, arm or hand with very little actual neck pain). Onset of pain may be immediate or occur some hours after exertion or an injury. There may be a slow onset - pain gradually increases over several days or weeks.

Sex or Age Most Affected

Adults of both sexes, usually between ages 20 and 40.


Pain or deep ache of the neck, shoulder or arm(this needs to be differantiated from true shoulder pain, such as tendonitis\bursitis). There may be burning or tingling of the arm or hand or headaches. It may be continuous, or only occur when you are in a certain position. The pain may be aggravated by turning your head, looking up or looking down ( as with reading).
limited range of motion (less than normal movement) of the neck.
Stiffness of the neck and shoulder muscles.


  • postural strain ( improper position when sitting - reading - working at a computer)
    Severe blow or fall.
  • Car accident
  • Heavy lifting.
  • Sleeping without good neck support/sleeping on your stomach
  • Turning over while you are asleep. Then waking up with a "stiff neck."
  • Degenerated/ ruptured cervical disc.
  • Bone spur.
  • Nerve dysfunction.
  • Osteoporosis, tumors.
  • Spondylosis (hardening and stiffening of the spinal column).
  • Congenital problem.
  • Often there is no obvious cause.
  • Risk Increases With
  • Sitting for long periods and bending your head /neck forward. (desk work, cooking, etc.)
  • Participation in sports without warming up ( stretches).
  • Sharp increase in athletic activity (weekend athlete)
  • Poor posture with sitting - sleeping.
  • Frequent travel on planes.
  • Falling asleep sitting up.(head hanging down)

How to Prevent

  • Exercises to strengthen /stretch neck and shoulder muscles.
  • Learn how to sit and work without bending your neck.
  • Proper back & neck support for your car/bed/sofa/chair.

Friday, January 27, 2006

A Pilot Clinical Trial of OMT and Pregnancy by the national Osteopathic Research Center

Source: Visit the national Osteopathic Research Center for more on their current research studies.

A woman’s first pregnancy brings about adverse changes in her biomechanical structure and overall physiology that commonly leads to problems before, during and after her delivery. There is evidence that Osteopathic Manipulative Treatment (OMT) is used extensively in pregnant patients. We propose to conduct a prospective randomized, blinded, controlled pilot study to examine the effect of OMT on pain and quality of life during and after the third trimester of a first pregnancy.

84 primigravida subjects will be recruited and randomly assigned to one of three treatment arms of this pilot study: 1) OMT; 2) sub-therapeutic placebo ultrasound; and 3) no treatment. During the participants’ third trimester and post-partum period, they will all receive standard obstetrical care from their obstetricians at the University of North Texas Health Science Center-Fort Worth, Obstetrics & Gynecology (OB/GYN) Clinic. Subsequently, they will deliver their babies at the Osteopathic Medical Center of Texas. Our primary outcome measure will be to evaluate the efficacy of OMT in: 1) decreasing low back and pelvic pain in the pre- and post-partum period; and 2) improving the overall quality of life in the pre- and post-partum period. Our secondary outcome measure will be to preliminarily examine the efficacy of OMT to decrease the incidence of complications of pregnancy, labor, and delivery. Pain in the low back and pelvis will be separately evaluated at each pre- and post-natal visit using the Quadruple Visual Analog Pain Scale. Treatment effects on disability and quality of life will be assessed utilizing the Roland-Morris Low Back Pain and Disability Questionnaire and the SF-12v2 Short Form General Health Survey. The relative potencies of placebo effect in each of the three treatment arms will be assessed via a Subject Confidence-in-Treatment Assessment administered at the beginning and end of the study. Pregnancy complications will be recorded and analyzed for treatment effects. Statistical analysis will seek to determine the significance of epidemiological cofactors versus treatment effects among the three treatment groups before drawing definitive conclusions.
If a positive treatment effect is discovered, this project will be followed by a multi-center study of sufficient statistical power to definitively determine the clinical efficacy of OMT in conjunction with standard obstetrical care of third trimester primigravida women.

Tuesday, January 24, 2006

Osteopathic Treatment to the Common Cold: Additional benefits using Ostepathic Manipulative Treatment (OMT)

Source: Fighting%20the%20Common%20Cold.doc

Sore throat, aching muscles, runny nose, headaches, back pain, short of breath and fever. Yes, we are all familiar with the symptoms of the common cold, and most of us know no other way to relieve symptoms other than taking cold and flu tablets, antibiotics or trying home remedies that rarely work. Ever wanted to use drug free treatment that does work? Osteopaths use 100% natural, drug free, non-invasive methods to alleviate nasty cold symptoms.

We’ve all suffered at some time from the common cold. In fact adults average 2 to 3 colds per year while children average 6 to 10 colds per year. Osteopaths can reduce your cold symptoms, so you are guaranteed a good night’s sleep. To understand how they do this, we must first look at what causes the symptoms of a common cold.

Cold symptoms are due to viruses imbedding in the tissues of the nose and throat. Our body responds by creating watery mucous. The viruses then cause damage and inflammation to healthy cells, resulting in the activation of surrounding sympathetic nerves.

Sympathetic nerves send messages to the neck and upper back areas of the spine, causing tight muscles and pain. Activation of the sympathetic nerves also causes the throat

and nose tissues to produce thick, slow-moving mucous, resulting in a blocked nose.

The tight neck and shoulder muscles, thick mucous and irritated spinal areas cause congestion of the blood and lymphatic fluids, which makes you feel even more congested.

This is one of the many systemic conditions that Osteopaths often treat in conjunction with a G.P or other health professionals. Osteopaths relieve these symptoms by using traditional osteopathic techniques including soft tissue manipulation, stretching, passive mobilisation, articulation, muscle energy techniques and myofascial release to:

Stimulate blood supply, therefore increasing the immune response

Increase venous and lymphatic drainage which results in decreased congestion

Decrease joint facilitation and sympathetic nerve stimulation, therefore decreasing mucous production

Decrease muscle spasm and pain

Increase relaxation and improve sense of well-being

Make a speedier recovery

Osteopath Kylie Read explains, “The Body is designed to fight colds using its immune system. A key component of this is your lymphatic. Osteopaths help your lymphatics to do its job more effectively, by relieving muscle spasms, pain, and congestion. Maximizing lymphatic drainage will help to relieve the cold by allowing your immune system to function at its best.”

Sunday, January 22, 2006

Healthy Aging and Osteopathic Manipulative Treatment (OMT)

Source: Osteopathy/Relieving_oldage_prob.shtml

A few old-age symptoms respond well to manipulative therapy. Persons of fifty years of age and over experience some stiffness of the cervical spine. They feel disturbed while sleeping, putting the blame on the faulty position of their sleeping pillow or prolonged fatigue. Sometimes a little disturbance is sufficient to bring about a headache. It may be caused by bad posture or a wrong way of doing work or inactivity. Relief is felt by taking a painkiller or by applying warm water to the upper back. Such people find difficulty in balancing themselves, and are afraid of crossing the road on their own. They feel as if they are going to fall down. They feel giddy when they turn their head to one side or while bending it backwards. They may have ringing in the ear, or suffer a hearing loss. They feel as if they have specks of dust in front of their eyes. Occasionally they may also experience difficulty in speaking or hoarseness, hot flushes or perspiration. Nose or eye secretions may increase or decrease.

Psychic disturbances among old people are very common. They complain of mental fatigue, difficulty in concentration, loss of memory, depression and anxiety These symptoms can occur in various combinations and with a varying degree of intensity.

Results of Manipulation
Giddiness and headache respond very well to manipulation. Fatigue in the eyes improves to a considerable degree. Manipulation has a good effect on nose and eye secretions too. Ear noises can be lessened a little bit, but the results are not satisfactory. Sometimes these patients are forced to take psychiatric treatment. Dr. Feld, a neurosurgeon, drew attention to disturbances of cervical origin. These symptoms are now accepted as being related to vertebral artery insufficiency; cervical manipulation is justified in these cases.

Case History
A 74-year-old lady suffered from stiffness and occasional pain in the neck. Both shoulders used to pain and this went on for several years. She had spells of giddiness lasting for a few minutes each. On a few occasions she was semi-conscious for about ten minutes to half an hour. She did not remember things and her sleep was disturbed.

The patient was treated with articulation and mild manipulation of the cervical spine. Her giddiness became less frequent, and she became more alert. She could move around in the house more easily and did not need help. She also felt relief from her shoulder pain.

When choosing a physician remember, there are only TWO types of fully qualified physicians.
D.O.s comprise a separate, yet equal branch of American medical care. Together, D.O.s and M.D.s enhance the state of care available in America. It is, however, the ways that D.O.s and M.D.s are different that bring an extra dimension to your family's health care.

Osteopathic Manipulation Explained



Osteopathy originated as a 19th century alternative medical approach focusing on physical manipulation. Today, osteopathic physicians study and practice the same types of medical and surgical techniques as conventional medical doctors. Some of osteopathy's original techniques still persist, however; these, taken together, are called osteopathic manipulation (OM). OM is less well-known to the public than chiropractic spinal manipulation, but it has shown promise for many of the same conditions: for example, back pain and tension headaches.

History of Osteopathic Manipulation
Osteopathic medicine was founded in 1874 by Andrew Taylor Still, a U.S. physician. Physicians educated in this method were called doctors of osteopathy, or D.O.s. Subsequently, however, schools of osteopathic medicine became integrated with conventional medical schools, and today the license of D.O. is legally equivalent to that of M.D.

Forms of Osteopathic Manipulation

Osteopathic and chiropractic techniques overlap, but they are not identical. As a general rule, chiropractors focus most of their attention on the spine, while osteopathic practitioners devote more of the their efforts to the manipulation of soft tissues and joints outside the spine. Another general difference is that chiropractic spinal manipulation tends to make use of rapid short movements (spinal manipulation, which is a high-velocity, low-amplitude technique), while OM typically concentrates on gentle, larger movements (mobilization, which is a low-velocity, high-amplitude technique). But neither of these distinctions is absolute, and many chiropractic and osteopathic methods do not fit neatly into these categories.

There are several specific osteopathic techniques in wide use, many of which are named after their founders. Some of the more popular are Greenman muscle-energy, Jones counterstrain (also known as strain-counterstrain), myofascial release, and cranial-sacral therapy (formally known as osteopathy in the cranial field).

Greenman Muscle-energy Technique
Greenman muscle-energy technique involves bending a joint just up to the point where muscular resistance to movement begins (“the barrier”), and then holding it there while the patient gently resists. The pressure is maintained for a few seconds and then released. After a brief pause to allow the affected muscles to relax, the practitioner then moves the joint a little farther into the barrier, which will usually have shifted slightly toward improved mobility during the interval.

Strain-counterstrain Technique (Jones Counterstrain)
Strain-counterstrain technique (Jones counterstrain) involves finding tender points and then manipulating the joint connected to them in order to find a position where the tenderness decreases toward zero. Once this precise angle is found, it is held for 90 seconds and then released. Like muscle-energy work, strain-counterstrain progressively increases range of motion and, it is hoped, decreases muscle spasm and pain.

Myofacial Release
Myofacial release focuses on the fascial tissues that surround muscles. The practitioner first positions the painful area either at the edge of the barrier to movement or, alternatively, at the opposite extreme (the area of greatest comfort). Next, while the patient breathes slowly and easily, the practitioner palpates the fascial tissues, looking for a subtle sensation that indicates the tissues are ready to “unwind.” After receiving this indication, the practitioner then helps the tissue to follow a pattern of spontaneous movement. This process is repeated over several sessions until a full release is achieved. Myofascial release is said to be especially useful in pain conditions that have persisted for months or years.

Cranial-sacral Therapy

Cranial-sacral therapy, more properly called cranial osteopathy (or just cranial for short), is a very specialized technique based on the scientifically unconfirmed belief that the tissues surrounding the brain and spinal cord undergo a rhythmic pulsation. This “cranial rhythm” is supposed to cause subtle movements of the bones of the skull. A practitioner of cranial-sacral therapy gently manipulates these bones in time with the rhythm (as determined by the practitioner’s awareness), in order to repair “cranial lesions.” This therapy is said to be helpful for numerous conditions ranging from headaches and sinus allergies to multiple sclerosis and asthma. However, many researchers have serious doubts that the cranial rhythm even exists.11

What is Osteopathic Manipulation Used For?

Osteopathic manipulation is primarily used to treat musculoskeletal pain conditions, such as back pain, shoulder pain, and tension headaches. OM is often said to be specifically effective for conditions that have persisted for some time, as opposed to chiropractic spinal manipulation, which, according to this view, is most effective for treatment of injuries that have occurred recently. However, there is no meaningful scientific support for this belief.
Some advocates of OM believe that it has numerous additional benefits, including the enhancement of overall health and well-being.

Possible Effects of OM
Most studies of OM have involved its potential use for various pain conditions.
In a study of 183 people with neck pain, use of osteopathic methods provided greater benefits than standard physical therapy or general medical care.12 Participants receiving OM showed faster recovery and experienced fewer days off work. OM appeared to be less expensive overall than the other two approaches; however, researchers strictly limited the allowed OM sessions, making direct cost comparisons questionable. Another study evaluated a rather ambitious combined therapy for the treatment of chronic pain resulting from whiplash injury (craniosacral therapy along with Rosen Bodywork and Gestalt psychotherapy).13 The results failed to find this assembly of treatments more effective than no treatment.

In a 14-week, single-blind study of 29 elderly people with shoulder pain, real OM proved more effective than placebo OM.1 Although participants in both groups improved, those in the treated group showed relatively greater increase in range of motion in the shoulder.

In another study, 24 women with fibromyalgia were divided into five groups: standard care, standard care plus OM, standard care plus an educational approach, standard care plus moist heat, and standard care plus moist heat and OM.2 The results indicate that OM plus standard care is better than standard care alone, and that OM is more effective than less specific treatments, such as moist heat or general education. However, because this was not a blinded study (participants knew which group they were in), the results can’t be taken as reliable.
A study of 28 people with tension headaches compared one session of OM against two forms of sham treatment, and found evidence that real treatment provided a greater improvement in headache pain.3

Although OM has shown some promise for the treatment of back pain,4,5 one of the best-designed trials failed to find it a superior alternative to conventional medical care. In this 12-week study of 178 people, OM proved no more effective than standard treatment for back pain.6 Another study, this one enrolling 199 people and following them for 6 months, also failed to find OM more effective than fake OM.14 This study also included a no-treatment group. Both real and fake OM were more effective than no treatment.

A much smaller study reportedly found that muscle-energy technique enhances recovery from back pain, but this study does not appear to have used a meaningful placebo treatment.15
Some studies have evaluated the potential benefits of OM for speeding healing in people recovering from surgery or serious illness. The best of these studies compared OM against light touch in 58 elderly people hospitalized for pneumonia.7 The results indicate that use of osteopathy aided recovery.

In a much less meaningful study, OM was compared to no treatment in people recovering from knee or hip surgery.8 While the people receiving OM recovered more quickly, these results mean very little, since, as noted above, any form of attention should be expected to produce greater apparent benefits than no attention.

A similarly weak study suggests that OM might also be helpful for people hospitalized with pancreatitis.9

A small study found some evidence that OM might be helpful for childhood asthma.16

Finding a Qualified Practitioner of Osteopathic Manipulation
Although there are many licensed doctors of osteopathic medicine (DOs), most practice conventional medicine and do not specialize in OM. Some do, and many of those have been certified by the American Osteopathic Board of Neuromusculoskeletal Medicine.
In addition, many physical therapists and massage therapists use some osteopathic techniques, with variable amounts of training.

Safety of Osteopathic Manipulation
Most forms of OM, because of their gentle nature, are believed to be quite safe. However, mild short-term pain may occur immediately following treatment.10 In addition, some osteopathic practitioners use the high-velocity thrusts common to chiropractic, and might therefore incur some slight safety risks. Overall, OMT is very safe.

1. Knebl JA, Shores JH, Gamber RG, et al. Improving functional ability in the elderly via the Spencer technique, an osteopathic manipulative treatment: a randomized, controlled trial. J Am Osteopath Assoc. 2002;102:387–396.
2. Gamber RG, Shores JH, Russo DP, et al. Osteopathic manipulative treatment in conjunction with medication relieves pain associated with fibromyalgia syndrome: results of a randomized clinical pilot project. J Am Osteopath Assoc. 2002;102:321–325.
3. Hoyt WH, Shaffer F, Bard DA, et al. Osteopathic manipulation in the treatment of muscle-contraction headache. J Am Osteopath Assoc. 1979;78:322–325.
4. Newswanger DL, Patel AT, Ogle A. Osteopathic medicine in the treatment of low back pain. Am Fam Physician. 2000;62:2414–2415.
5. Koes BW, Assendelft WJ, van der Heijden GJ, et al. Spinal manipulation for low back pain. An updated systematic review of randomized clinical trials. Spine. 1996;21:2860–2873.
6. Andersson GBJ, Lucente T, Davis AM, et al. A comparison of osteopathic spinal manipulation with standard care for patients with low back pain. N Engl J Med. 1999;341:1426–1431.
7. Noll DR, Shores JH, Gamber RG, et al. Benefits of osteopathic manipulative treatment for hospitalized elderly patients with pneumonia. J Am Osteopath Assoc. 2000;100:776–782.
8. Jarski RW, Loniewski EG, Williams J, et al. The effectiveness of osteopathic manipulative treatment as complementary therapy following surgery: a prospective, match-controlled outcome study. Altern Ther Health Med. 2000;6:77–81.
9. Radjieski JM, Lumley MA, et al. Effect of osteopathic manipulative treatment on length of stay for pancreatitis: a randomized pilot study. J Am Osteopath Assoc. 1998;98:264–272.
10. Knebl JA, Shores JH, Gamber RG, et al. Improving functional ability in the elderly via the Spencer technique, an osteopathic manipulative treatment: a randomized, controlled trial. J Am Osteopath Assoc. 2002;102:387–396.
11. Hartman SE, Norton JM. Craniosacral therapy is not medicine. Phys Ther. 2002;82:1146–1147.
12. Korthals-de Bos IB, Hoving JL, van Tulder MW, et al. Cost effectiveness of physiotherapy, manual therapy, and general practitioner care for neck pain: economic evaluation alongside a randomised controlled trial [electronic version]. BMJ. 2003;326:911.
13. Ventegodt S, Merrick J, Andersen NJ et al. A Combination of Gestalt Therapy, Rosen Body Work, and Cranio Sacral Therapy did not help in Chronic Whiplash-Associated Disorders (WAD) - Results of a Randomized Clinical Trial. ScientificWorldJournal. 2005;4:1055-68.
14. Licciardone JC, Stoll ST, Fulda KG, et al. Osteopathic manipulative treatment for chronic low back pain: a randomized controlled trial. Spine. 2003;28:1355-62.
15. Wilson E, Payton O, Donegan-Shoaf L, Dec K. Muscle energy technique in patients with acute low back pain: a pilot clinical trial. J Orthop Sports Phys Ther. 2003;33:502-12.
16. Guiney PA, Chou R, Vianna A, et al. Effects of osteopathic manipulative treatment on pediatric patients with asthma: a randomized controlled trial. J Am Osteopath Assoc. 2005;105:7-12.

What would you say to those just coming into medicine?

Source: 2005/Tx_DO_April_2005.pdf

To those coming into osteopathic medicine—be PROUD of your profession, do not give up your OSTEOPATHIC ROOTS, remember who trained you, support your OSTEOPATHIC ORGANIZATIONS. Our profession is a lifelong learning experience and you are never too old to learn. Whenever you can, talk with the older D.O.s and learn their OMT techniques.

Thursday, January 19, 2006

New Osteopathic Medical School Announced!

Source: LMU makes plans for College of Osteopathic MedicineKingsport Times News, TN - Jan 18, 2006

Yet another opportunity to learn OMT!

Lincoln Memorial University officials have announced plans to open a College of Osteopathic Medicine at the college's main campus.
LMU has notified the Southern Association of Colleges and Schools' Commission on Colleges (SACS COC) of school officials' intent to seek accreditation and award doctoral degrees in osteopathic medicine.
The new program will become LMU's first level 5 doctorate-level degree program. Approval is required from both SACS COC and the American Osteopathic Association's Commission on Osteopathic College Accreditation (AOA COCA) to achieve regional and professional accreditation of the program, said LMU spokeswoman Kate Reagan.
The decision to pursue the osteopathic medicine program was made after a feasibility study was done.
LMU first submitted a letter to AOA COCA requesting applicant status last summer, Reagan said.
"Following the completion of an exhaustive feasibility study by the university ad-hoc steering committee, the LMU Board of Trustees voted unanimously to support the development of a College of Osteopathic Medicine," she said. "A pre-accreditation application was accepted, and the university was evaluated by a visiting team from AOA COCA on Oct. 13, 2005."
Pre-accreditation status was granted to the university in December.
Recruitment of students will begin following final accreditation from SACS COC and AOA COCA.
LMU officials set the fall semester of 2007 as a target date for the beginning of classes, Reagan said.
The new school of medicine will be on LMU's main campus in Harrogate.
The first two years of the program will be offered at the main campus, Reagan said. But students will spend most of the last two years working in health care agencies in a corridor extending from Harrogate to Chattanooga. The bulk of clinical training will be conducted in Knoxville.
"Establishment of this College of Osteopathic Medicine will have a significant economic, health care and educational impact on the region," said LMU President Nancy B. Moody. "The growth that will occur as a result of this program will be felt far and wide."

Tuesday, January 17, 2006

Tennis Elbow Treatment and Osteopathic Manipulative Treatment Book Pick


About the Book

Tendon and Ligament Healing
By William Weintraub, M.S.
236 pages58 illustrations and photos.
Second revised, expanded edition, 2003 Paradigm Publications 7" x 10" 236 pages Price: $22.95, trade paper ISBN: 0-912111-73-9 Distributed to the book trade by Redwing Book Company

Here is a clear, solid basis for non-surgical recovery from high numbers of chronic, unyielding sports and work injuries with the author's new hands-on osteopathic-style approach that is a breakthrough in tendon and ligament healing. It will hold strong interest for athletes and all active people, therapists, sports/movement trainers, and people seeking effective health care options.

The book features thorough case accounts of recovery, guidelines for self-care and sports injuries, dynamic research in the field, and illustrates techniques of this innovative low-force treatment. Serious ligament or tendon injuries are usually thought to have no hope of recovery without surgery, which has had very mixed results.

"This is an important publication because of the skills, light and optimism it brings to chronic tendon/ligament injury. Weintraub escapes a certain pessimism inherent in the standard treatment in this area, and he offers new possibilities for therapists and patients alike when dealing with these difficult problems, with his effective approach." -- Fritz Frederick Smith, M.D., founder, Zero Balancing; author, Inner Bridges

"an in-depth and impressive review of connective tissue dynamics. Weintraub's case reports allow the reader to follow a step-by-step process of his evaluation and treatment procedures resulting in a successful outcome where traditional rehabilitation approaches have failed." -- Sandy L. Burkart, Ph.D., P.T., past President, Orthopaedic Section, APTA

"Bill Weintraub is a skilled practitioner, his patients call him a true healer. I consider Bill an invaluable resource for the people we see in Dancemedicine, many of whom need help with serious tendon and ligament problems. -- Diana Herold, Dancemedicine Supervisor, St. Francis Memorial Hospital, Center for Sports Medicine

This book illustrates the innovative treatment model that Weintraub has developed for these injuries.

17 thorough case accounts and an illustrated technique section demonstrate this low-force manual method for a variety of injuries, avoiding surgery while promoting full recovery.
The book aids people's involvement in their own healing process through its many useful suggestions.

"As a practicing orthopaedic surgeon, I find Bill Weintraub's approach to chronic tendon/ligament injury to be innovative and refreshing. In his synthesis of conventional and complementary wisdom Weintraub has created a valuable new approach to the manual therapy methods for handling recalcitrant inflammatory processes. -- A.B. Flick, M.D., Dipl. American Board of Orthopaedic Surgery, American Academics of Pain, Wound Management
Weintraub has written a synthesis of recent scientific research on connective tissue which reveals a more potent healing response of tendons/ligaments than found in standard medical theory.

It provides insight into the training and essential attributes of the therapist.
"Bill Weintraub has written this book with the careful, comprehensive attention with which he approaches each of his patients. His creative intelligence and subtle hands-on mastery make this an essential book for clinicians treating and persons suffering from chronic tendon and ligament injuries who believe that if they only knew how, healing is a natural process. -- Bonnie Bainbridge Cohen, O.T.R., founder, Body-Mind Centering; author, Sensing, Feeling and Action

"Bill Weintraub, M.S., is at the same time an excellent therapist and a researcher who has produced this very valuable, clear, highly interesting work in the area of tendon/ligament treatment. -- Jean-Pierre Barral, D.O., Chairman, Dept. of Manipulation, Faculty of Medicine, Paris du Nord; author, Visceral Manipulation I and II, The Thorax

Tennis Elbow Treatment and Osteopathic Manipulative Treatment Exercises

Source: directory/tennis-elbow-injury.html

Tennis Elbow Treatment

Tennis elbow is the common name for the inflammation of the tendons (also know as tendonitis ) attached to the lateral, or outside, of the elbow at the bony bump of the humerus. ( upper arm bone ). The medical term for this bony prominence is called the lateral epicondyle, which is the reason that the condition is also refered to as 'lateral epicondylitis'. The muscles that move the wrist and fingers attach to a tendon that is connected to the bone structure in this area. Tennis elbow patients suffer experience pain on the outer or top part of the elbow. This pain may be experienced farther up the forearm and occasionally even in the hand. The pain is felt during grasping activities and may be accompanied by a feeling of weakness. Sufferers may have an dull ache in the area that is present at rest or at night after activity. Once the tendons become irritated and inflammed is it difficult for them to heal on their own because these tendons are constantly used every time the hand grips or squeezed anything.

Tennis Elbow Causes

Tennis elbow treatment ( lateral epicondylitis ) may result from a sudden violent injury. Repetive Stress Injury ( RSI ) is a much more common cause of tennis elbow because the constant repitition 'overload' the tendons beyond their ability to repair themselves. This repetive stress could come from motions in sport or at work, or even from a change in one regular activity. Such a change could be the result of playing more tennis than usual that results in lateral epicondylitis. A weekend of gardening, tinkering with tools or even opening a very tightly shut jar could lead to an instance of tennis elbow. The key elements seems to be any activity that involves constant squeezing or gripping. A similar condition can occur on the inside of the elbow. This condition is know as medial epicondylitis or 'Golfers elbow' ?

Is Tennis Elbow a serious condition?

Tennis elbow may be painful, it usually does not lead to serious problems. However, if the condition is untreated or becomes very painful, the patient could experience loss of function and loss of motion at the elbow. Tennis elbow treatment in these cases may be a little more difficult, rarely does it result in long term disability.

Tennis elbow is primarily considered a Repetitive Stress Injury( RSI ), the first course of action is to rest the elbow so that it can begin to heal itself.

If you are suffering from tennis elbow, you should first try to identify the movement causing the inflammation. Sometimes this is simple. If you are an avid tennis player, then swinging a tennis racquet is the most likely culprit.

Think about what activities you were involved during the time that you first notices the tennis elbow pain. The most common movements leading to tennis elbow are repetitive motions and/or very strong gripping movements, squeezing objects and heavy lifting.

Saturday, January 14, 2006

Myofascial Release and Craniosacral Therapy

Source: myofascial-craniosacral-accuprin.htm

Myofascial Release and Craniosacral Therapy are effective in the treatment of:

Myofascial pain
Headaches and migraines
Fibromyalgia and other connective-tissue disorders
Chronic fatigue syndrome
Women's health issues
Pelvic and menstrual problems
Acute and chronic pain
Chronic neck and back pain
Carpal tunnel syndrome
Temporomandibular joint syndrome (TMJ)
Restriction of motion
Post-traumatic stress disorder
Post-surgical dysfunction
Stress- and tension-related problems
Attention deficit disorders
Repetitive stress and sports injuries
Orthopedic problems
Neurological dysfunction
Central nervous system disorders
Traumatic brain and spinal cord injuries
Infantile disorders
Learning disabilities
Emotional difficulties
Neurovascular or immune disorders

Search this blog for more articles

Correct Posture, Osteopathic Medicine, DOs are the source of leading expertise in helping patients improve their posture and spine health.

Source: Osteopathy/Adopting_Correct_Posture.shtml

'My bed is so cozy, nice and soft. When 1 sleep I sink into it, I am in a dreamland and I feel wonderful and so fresh in the morning. I love my bed, it is so dear to me.' 'Disgusting!' said the osteopath.

'I have never played any game in my life. When I was young I entertained myself with novels and movies, or kept myself busy with my course books; I was a bookworm. When I got married, I hardly had any chance to participate in games. My house is well equipped with modern gadgets and amenities so that I hardly exert myself physically.' 'Frustrating!' said the osteopath.
'I was tall with good features, but since I was tall I could hardly hold myself erect. This was also due to the natural instinct of a teenaged girl. I gradually developed a habit of walking and sitting with a forward stoop. I cannot change it now.' 'So unmindful!' said the osteopath.

'If you go to Rajasthan, watch the ladies carrying a number of water pitchers on their heads. They walk miles and miles to bring water for the cooking and daily washing. It is a pleasure to see them walking. They walk so straight and their walk looks so very graceful.' 'Wonderful, it is healthy!' said the osteopath.

'Do you see boys making pyramid formations in a circus or on the streets of Bombay to bring down the pitcher hanging high and tied to a rope on janmashtami They make human pyramids, one boy over another, to reach the top to break the pitcher. Only a team of healthy and stout boys with straight backs can play this game and succeed ‘ .‘It must be very interesting and so healthy!' said the osteopath.

'We live in a village and our work involves hard labor in the fields and at home. When we are young we go to the akhada to do dand-baithak and wrestling. We perspire, we rub mud on our bodies, we take a swim, we feel fresh and fine. We cannot afford thick mattresses, so we just spread a little rug on the ground and fall into a dreamless sleep, only waking up in the morning. We feel fine and energetic; we feel like pushing and -punching somebody.' 'You have the healthiest habits in the world!' said the osteopath.

At the London College of Osteopathy, we used to hear an interesting story about a man called Frederick Matthias Alexander. He used to cure his patients of their aches and pain, only by teaching them how to stand and sit correctly and how to do different activities using the correct posture. He cured his patients just by correcting their posture! This may appear very surprising, but it is true. Osteopaths are very careful about the posture of their patients. They tell their patients how to correct their posture and do corrective exercises, so that once they are- cured of their ailment, it will not recur. Medical men today are conscious of the role that posture plays in the etiology of different diseases.

It is very important to know how one should carry one‘ s body. A humped back and vertebrae contracted together cause back pain. The neck sunk down on the chest causes stiffness in the neck, pain in the arm and headaches. When we stand erect, how many of us put equal pressure on both the legs? All the body weight is usually put on one leg, putting a constant strain on the pelvis and lumbar spine. Bad posture keeps our muscles tense.

How many teachers or parents are watchful of their child's posture? The correction of posture in a child is much easier than in grown-ups and elderly people. Healthy habits developed by a child help him right through his life. As parents or teachers, we should be conscious of how a child sits and if the posture is incorrect, we should point it out to him and take care to keep on correcting it. It is very important to see how a child sits, reads, writes, walks and plays.

Spinal curves are absent at birth and during the first few weeks of life, there is one continuous curve as the child is curled up in the womb. This primary curve undergoes changes as the child grows and lifts up his head, tries to sit, crawl, stand, walk and run. At the age of three months when the child tries to lift his head and look around, the upper secondary curve in the spine - from the first cervical to the first dorsal vertebrae - starts developing. By nine months when the child is able to sit, this curve is convex forward.

The lower spinal curve (lumbar) from the first lumbar to the fifth lumbar vertebrae appears between twelve to eighteen months when the child tries to walk. It is more prominent in females than in males.

The thoracic curve from the second to the twelfth thoracic vertebrae is concave forward. The pelvic curve from the lumbosacral joint to the coccyx faces downwards and forwards.

The primary thoracic kyphosis (bending forward at the thorax) present at birth is maintained; the cervical and lumbar lardosis (bending backward at the lower spine) are developed during the process of growth, so that man can assume an erect posture.

Biologically speaking the lumbar and cervical (neck) curves emerged after man acquired an erect posture during the evolution of human life.

Mechanically these curves are so constructed due to the structure of the vertebrae, that they are maintained even when we lie on the floor or an extremely hard bed. If these curves are excessive, they are a causative factor for different aches and pains. For example, the spinal joints most vulnerable to internal derangement are between the fifth and sixth cervical, and fourth and fifth lumbar vertebrae - the area of the spine where the cervical and lumbar lardosis is most marked.

From early childhood every effort should be made to prevent future backache. Back pain is a universal symptom. So the aesthetic consideration of a child's posture and mechanism of disc protrusion should be a consideration before selecting exercises for children. In adulthood when disc degeneration has already started and the spine is comparatively stiff, exercises suddenly forcing a person to bend forward should not be included; if included at all, enforcement should be gradual, so that the spinal ligaments are able to retain their elasticity and undue damage is not caused by sudden force. A patient with back pain should not be advised to do forward bending exercises. Sometimes even when a sufferer from back pain finds that flexion exercises increase his discomfort, he is asked to do these exercises. Amy exercise which aggravates pain during or after it has been done, is harmful. It is a symptom of injuring a sore spot and healing of the pain is delayed by such exercises.

Selecting the Right Bed

While selecting a bed due importance should be given to posture and spinal anatomy. Most people are not aware of these considerations. In fact, with affluence and luxurious living, things are changing for the worse rather than the better. Cotton mattresses are being replaced by foam mattresses. The thickness and number of pillows used by an individual are increasing. Springs are often added beneath these foam mattresses. A comfortable bed is considered to be one into which you sink in. Is that correct? Very definitely not!
It is important to keep the spine as straight as possible while sitting, standing or doing any job. Equally important is to help the spine to remain as straight as possible while lying in bed, and even more so when you are suffering from back pain or neck pain.

Let us consider what a soft bed does to your spine. When you lie on a soft bed the heavier part of the body sinks deeper into the bed, and the lighter part of your body stays up in bed, thus increasing the curvatures of the spine and putting a lot of undesired strain on it. Thick pillows worsen this situation. The thicker the pillow, the more you flex your cervical spine, which is again an unnatural strain.the lumbar lordosis to be maintained in a position of maximum comfort.

The best remedy for your tired back after a whole day's work is to lie down just for a few minutes with your back flat on the ground and you will feel relaxed.
Buddhists in ancient India lived in a monastery which consisted of a large hall with small rooms all around in the monastery. These rooms were often made by digging into big rocks, and stand to this date. Beds were also made by cutting into the rocks; these were for meditation and for the monks to sleep on.

There is an interesting sb1oka in Bhav Prakash by Rajeshwar Dutt Sashtri. This is one of the most authentic books on ancient Ayurveda.vata, the energy which can get stuck in any part of the body and cause pain. Charaka, a famous teacher- of Ayurveda, mentioned that 'the person who feels lazy due to discomforts in the body, and wants to sleep, should sleep on a somewhat hard bed' (asukha shaiyya).

When a person changes from a soft to a hard bed, he feels a little discomfort and slight, stiffness in the beginning, but this phase passes off quickly'an4 he later feels comfortable and relaxed.
A person who is healthy and does not have any back problem should have a bed with a solid base and a comfortable mattress, two to three inches thick. It can even be a foam mattress which is one inch thick. If there is a spring in the mattress, a wooden board should be placed on top of it and then a thin mattress. A patient with a spinal disc problem should be provided with a harder bed.

If pain and stiffness are felt after a night's sleep, it is an indication that the bed is faulty. During sleep, the muscles are relaxed and all the strain is tolerated by the ligaments. When these ligaments are stretched for a long time they start aching. This indicates that the bed is wrongly constructed and in spite of relaxing the spinal ligaments, it makes them taut, and pain is felt due to stretching of these ligaments.

Correcting Your Sitting Posture

Pain over the dorsal spine is very rarely due to a slipped disc. It is mostly due to the searing strain on the posterior ligaments of the spine, following a wrong posture. Due to the chronic habit of standing or sitting with a forward stoop, the patient develops a round back. This long-standing strain on the back weakens the spinal muscles. As the muscles are not able to take the strain, the strain passes on to the ligaments; and as the ligaments are continuously stretched for a long period, the body's compensation breaks and you start having back pain. When a patient has dorsal kyphosis, the site of the vertebrae placed at the summit of the dorsal curve feels most painful after fatigue. This pain may also radiate to the chest, shoulder and back. The cartilage of the disc is insensitive since it has no nerve supply and, therefore, the first sign of disc damage is due to the stretching of the supporting ligaments.

The prolapsed disc may bulge and stretch the posterior ligament. A thin disc leads to narrowing of the space between the adjacent vertebrae of facets, with a consequent strain on the ligament which causes pain.

Have you observed the statues and paintings of Buddha at Ajanta and Ellora? Buddha is always shown sitting in yoga mudra with his spine straight. Yoga mudra is the sitting posture for meditation. This posture frees the body from any strain on the spine so that it does not hurt and divert the attention of the person who is meditating. This posture has to be maintained for hours and therefore, it should be comfortable, and free of any pain or strain.

Yoga asanas called posture exercises were developed in India in ancient times, and were practised for generations. Asanas are taught by Yoga teachers to patients suffering from back pain; they take the form of back extension exercises.

A simple set of exercises of dand baithak practised in the villages of India has a beneficial effect on the spine. It takes off the strain from the spine and makes it fit to fight the other strains on the spine caused by the adoption of an erect posture.

To sit slumping in a low chair puts considerable strain on the lower back. If the posture of sitting is not correct any measure to relieve the low back pain will not be effective. The patient should sit right at the back of the seat and then rest against the back of the chair. An ordinary office chair is much better than a sofa. If the cushion is not of a proper design, a small pillow may be placed behind the small of the back.

While designing furniture - be it a bed, kitchen shelves, or cupboards - keeping in mind the right posture is important. As an osteopath, I remember being paid a big fee for designing the chairs for the British Airways aircraft.

Strengthening Muscular Control

Exercises are needed to tone up the muscles and to maintain a good posture. Slack muscles lead to poor posture and undue strain is passed on to the ligaments. Eventually ligaments stretch and further abnormal mechanical strain produces still more symptoms.

Poor muscle tone is inevitable if the number and kind of exercises done are insufficient. A person with poor muscle tone is much more vulnerable to mechanical strain than one with a normal or muscular build.

An office worker, for example, whose spinal muscles are slack and weak due to his unstrenuous job, is much more vulnerable to strain or sprains if he tries to lift something heavy or do gardening. On the other hand, a person who does his exercises daily or participates in games has muscles which are in good shape. The following example will give a complete picture:

When a person is ill and completely inactive in bed, he loses the strength of the muscles at the rate of 7 per cent a day.

To increase the power of the muscles, exercises should be chosen wherein two-thirds of the maximum muscle strength is used.

To maintain the strength at the same level, one-third of the maximum strength should be used.
The power of the muscles decreases if only one-fifth or less of the maximum muscle power is used.

Increase in firmness and tone of the muscles is the indication of increase in muscle power. To acquire hypertrophy of their muscles, weight lifters and body builders exercise their muscles to a point of considerable fatigue. Hypertrophy of muscles is not necessary for healthy living.
The muscles should not be forced beyond a certain limit. If they are exercised beyond the tolerable muscle limit, they cease to contract in spite of maximum mental effort, and become inflamed, swollen and tender to touch. The subsequent
contraction of muscles is painful for two to three days.

Mobility of the Spine

The intervertebral joints of the spine can be hypomobile (less mobile) or hypermobile (more mobile).
A hypermobile joint with elongated weak ligaments is more vulnerable to disc lesion. Hypermobility leads to impaired nutrition, and then degeneration and softening of the disc. In this case, as the supporting ligaments of the annulus fibrosus are weak, herniation of the disc is inevitable. Hypermobility also leads to injury and tearing of the ligaments, and when there is a prolapsed disc, it takes much longer to heal, as giving support and rest to these joints is difficult.
An incorrect lifting posture is the reason why we sometimes get vertigo or giddiness due to disturbances in the upper cervical spine. A faulty posture and gravity impede the return of blood to the heart. If a faulty posture is maintained for a long time, blood congestion takes place and difficulty in breathing may be experienced. The central nervous system depends upon the integrity of the spinal column. All the impulses coming and going between the brain, spinal chord and peripheral nerves have to pass through the intervertebral foramen which can be very easily disturbed by a faulty posture, and can, in return, affect any part of the nervous system. Certain precautions must be taken to avoid a strain on the spine.

* When you want to lift something heavy from the ground or bathe a child, or make the bed, do not stoop; sit and lift the baby for a bath.
* Do not twist the body while turning, but rather change the position of your feet and turn. Just bending down and turning to one side is the worst movement you can make.
* Do regular back-extension exercises and abdominal exercises to keep up the tone of the muscles.

Monday, January 09, 2006

To current DOs and osteopathic medical students: Does OMT Have Proved Benefit? Yes and many old osteopathic physicians know about the efficacy of OMT


"I think I know the main problem that the osteopathic medical profession faces today. After graduation, too many DOs intern in hospitals were OMT is never practiced, never mentioned, and, in some cases, even prohibited. So these poor, partially educated DOs never really get an opportunity to use OMT as it should be used. "

Here is an excellent article which shows what current DOs should do (consult currently practicing physicians who have incorporated OMT into their practice in their practice)

For example, check out what the osteopathic physician had to say about incorporating OMT into his practice.

"When I retired in 1988, I had 53 years and 5 months of clinical experience as an osteopathic physician—perhaps the most extensive general practice in Minnesota—and I had administered OMT an estimated 400,000 times. These treatments were my main therapeutic procedure. The fact that so many people drove daily 20 to 120 miles for my OMT sessions indicates to me that no expensive trials of OMT are necessary. All that needs to be done to verify the efficacy of OMT is to consult old timers such as myself! "

Please visit: Osteopathic Manipulative Treatment Out of a Horse and Buggy

Some quick facts about osteopathic medicine!

Source: cfm?L1=3&L2=102&L3=4.0000

Although osteopathic medicine started out as a drug-free approach to the practice of medicine, the vast majority of doctors of osteopathic medicine will prescribe medication as needed.

By combining all other medical and surgical therapies with osteopathic manipulative treatment (OMT), doctors of osteopathic medicine (DOs) offer their patients more—a comprehensive approach to health care—because they are taught to treat the whole person, rather than just a single condition.

Most DOs select careers in primary care—such as family practice, internal medicine, or pediatrics, while others practice specialties such as obstetrics and gynecology, surgery, and emergency medicine. Many practice in rural and low-income areas.

Andrew Taylor Still, DO, MD, the father of osteopathic medicine, developed the specialty in 1874 after becoming disillusioned with the practices of medicine. He wanted to reform the practice of medicine but ended up developing a new branch of it altogether.

Your DO will address various lifestyle factors during diagnosis and/or treatment, such as stress, diet, exercise and posture.

OMT is considered extremely safe but is unadvisable for certain conditions, including bone cancer, bone or joint infection, a protruding disk or osteoporosis. OMT is not advisable if you've had spinal-fusion surgery.

One form of OMT is cranial sacral osteopathic manipulation; this approach involves OMT applied to your head using gentle, rhythmic pressure. If this is something that interests you, ask for the specialist in this area.

Sunday, January 08, 2006

Myofascial Release


Myofascial Release principles:

  • Fascia covers all organs of the body, muscle and fasciæ cannot be separated
  • All muscle stretching is myofascial stretching.
  • Myofascial stretching in one area of the body can be felt and will affect the other body areas.
  • Release of myofascial restrictions can affect other body organs through a release of tension in the whole fascia system.
  • Myofascial release techniques work even though the exact mechanism is not yet fully understood.
The indirect myofascial release techniques are as follows:

  • With relaxed hand lightly contact the fascia.
  • Slowly stretch the fascia until reaching a barrier/ restriction.
  • Maintain a light pressure to stretch the barrier and wait for approximately 3-5 minutes.
  • Prior to release, the therapist will feel a therapeutic pulse (e.g. heat).
  • As the barrier releases, the hand will feel the motion and softening of the tissue.
  • The key is sustained pressure over time.

Friday, January 06, 2006

Osteopathic Manipulative Medicine For Ulnar Neuropathy by William H. Stager, DO

Source: aama_marf/journal/vol14_3/case4.html



Peripheral neuropathy is a common condition with a variety of possible causes and treatments.


To describe the use of medical acupuncture and osteopathic manipulative medicine (OMM) in a patient with traumatic ulnarneuropathy.

Design, Setting, and Patient

A 51-year-old man with left ulnar neuropathy due to accidental severing of the ulnar nerve at the elbow; following surgical repair, he reported muscle weakness, pain, and paresthesias.Intervention Acupuncture points PC 6, HT 3, LI 4, LI 10, SI 3, SI 8, and TE 5 were selected on the patient's left arm and hand, along with various adjunctive points in response to signs and symptoms. Osteopathic myofascial release techniques were integrated with the acupuncture program (40-minute treatment sessions every 2-3 weeks).Main Outcome Measure Ulnar sensory and motor improvement.Results The patient's symptoms improved after the 1st treatment. He was treated for 4 years with continued improvement, including 50% decrease in pain and 50% increase in range of motion.Conclusion Combined acupuncture and OMM demonstrated efficacy in the treatment of this patient with traumatic ulnar neuropathy.


Peripheral neuropathy is a common condition that affects millions of people in the United States annually. Its causes can include trauma, tumors, infections, diabetes and other metabolic diseases, vascular insufficiency, nutritional deficiencies (such as beriberi and pellagra), motor neuron diseases, and toxic exposures such as lead.1 Clinical manisfestations and symptoms can include pains of every degree, weakness and muscle wasting, and paresthesias such as numbness, tingling, and burning. Numerous treatments provide varying degrees of success, including acupuncture, osteopathic manipulative medicine (OMM) techniques, pain medications, and surgery.1 Case ReportA 51-year-old Florida man presented 4 months after accidentally cutting his left elbow. The cut was deep and completely severed the ulnar nerve where it is most superficial at the elbow joint. He underwent surgery that same week and the nerve was reattached. After surgery, the surgeon gave a poor prognosis regarding recovery of the use of the patient's arm and hand in the ulnar distribution. The patient was prescribed hydrocodone/acetaminophen once at bedtime for pain. He also requested the integration of more natural methods. The initial postsurgical physical examination revealed a healthy man with the following abnormal physical findings: ulnar muscle wasting, weakness, paresthesias of tingling, numbness, and burning, and a "claw" or hooked 5th finger unable to move. The patient had a weak handgrip and strength (3/5), diminished sensation in the 4th and 5th fingers, a 3-in scar on the medial elbow, and myofascial restrictions along the arm, forearm, and hand. Hand abduction, adduction, and flexion, which are functions of the muscles of ulnar distribution,2 were all reduced. METHODSMyofascial Release TechniquesVerbal consent was obtained from the patient for combined myofascial release techniques (OMM) and acupuncture treatment limited to his left upper extremity. The myofascial release techniques were a combination of direct (toward a restriction) and indirect (away from a restriction) techniques.3 These gentle, slow-motion maneuvers either stretched or shortened the soft tissue (muscles, tendons, ligaments, and fascia) throughout the left shoulder, arm, forearm, hand, and fingers as restrictions were palpated, identified, and treated/released. These techniques are recommended standards of care for the relief of myofascial restrictions and neuropathies.3 They were applied before and after the acupuncture treatments to release restrictions, encourage circulation, and enhance the acupuncture treatments (10 minutes of OMM, 20 minutes of acupuncture, then 10 minutes of OMM within a 40-minute treatment period).Medical AcupunctureAcupuncture was performed with sterile, single-use, stainless steel needles, 0.22 mm in diameter and 25 mm in length (Helio Medical Supplies Inc., Santa Clara, Calif). Only the left upper extremity was treated at the patient's request. Several points were selected after careful examination and identification of the scar area, the ulnar nerve pathway, regional nerve and blood vessel distribution to avoid injury, as well as myofascial and joint restrictions. Needles were inserted 25 mm in depth, for 20 minutes per session, either in manual tonification (i.e., pointing in the direction of the flow of the meridian and turned clockwise, eliciting a De Qi response) or neutral technique (i.e., no turning of the needle nor eliciting a De Qi response). Acupuncture points were chosen to affect the sensory and motor symptoms resulting from the ulnar nerve damage. Acupuncture points PC 6, SI 3, SI 8, LI 4, LI 10, TE 5, and HT 3 were needled, with 1 to 3 other points sometimes added or subtracted from the above regimen depending on the patient's response, signs and symptoms, and physician's findings. Those extra points were SI 4, PC 4, PC 5, LI 11, LI 12, and TE 8; they were chosen on the basis of either point tenderness or relief from pain or dysfunction. Also, 1 to 3 needles were placed around the 3-in scar at the medial elbow area to increase circulation, decrease scarring, and complement the basic treatment prescription. Treatments were scheduled in response to the outcome of each session and averaged approximately once every 2-3 weeks over 4 years.Although all the points described have many indications, the major rationale for using them was that each can be used for local sensory or motor symptoms in their anatomical and energetic areas of distribution.4RESULTSThe patient's sensory and motor signs and symptoms improved significantly after the 1st treatment. When he returned 2 weeks later, he stated that he felt stronger, more energetic, with increased sensation, and less stiffness. Increased sensation included both restored feelings in the hand and arm as well as an increased ability to feel. The patient's hand and arm pains and paresthesias had decreased 50% based on patient report using a 1-10 scale and by palpation; hand range of motion and hand and arm strength improved approximately 50%. The treatment was effective over 10-20 days; consequently, maintenance treatments were scheduled every 2-3 weeks. The patient continued to improve over the next 4 years. The strength in his left upper extremity was almost normal with some intermittent paresthesias of numbness, pain, and tingling. The 5th finger remained somewhat flexed.


This patient presented with traumatic ulnar neuropathy after accidentally severing the nerve at the left elbow and then having it reattached surgically soon thereafter. His signs and symptoms included motor and sensory loss, pain, paresthesias, weakness, and stiffness. The surgeon pronounced a justifiably poor prognosis. Treatment was begun using a combination of acupuncture points and myofascial manipulative techniques. The acupuncture points were selected because of their known effects on the local sensory and motor signs and symptoms, as well as their energetic properties.4 Most of the points were found along the distribution of the ulnar nerve. Points were also chosen for their energetic value since pain is described in Oriental concepts as resulting from blocked or stagnant energy and blood.5The patient experienced both trauma and surgery, which would be considered cause for blockage, stagnation, or both.5 Yin points (PC 4, PC 5, PC 6, and HT 3) were chosen for their effects of increased circulation and decreased pain and dysfunction; Yin points also move the energy in the direction from the arm to the fingers. Yang points (SI 3, SI 4, SI 8, LI 4, LI 10, LI 11, LI 12, TE 5, and TE 8) were chosen for their positive effects on circulatory and neuromuscular signs and symptoms. Yang points move energy in the direction from fingers to elbow and arm. Local points encircling the scar were also chosen for their ability to increase or enhance energy and effects (increased circulation and decreased scarring).6,7 Myofascial manipulative techniques were also used before and after acupuncture to loosen the restricted joints, muscles, and fascia, which in turn increased ranges of motion and circulation, and decreased pain and dysfunction.3 The patient reported significant relief from his symptoms after the 1st treatment. A treatment schedule of once every 2-3 weeks was eventually used since some symptoms returned after longer intervals. The patient's sustained and increasing improvements justified the methods and schedule and greatly improved his prognosis.Both acupuncture and OMM techniques have been used separately for the successful treatment of a number of neuropathies. A wide variety of acupuncture and manipulative techniques have evolved and been interwoven by ancient and modern practitioners and are recommended in modern textbooks.6,7 The rationale has been to affect the peripheral and central nervous system neurotransmitters and endogenous opioids to modulate pain and nerve response, increase circulation, and relax and normalize the neuromusculoskeletal system.3,7


This case report demonstrated the combined efficacy of acupuncture and OMM in the treatment of ulnar neuropathy. Further research is indicated to optimize combined acupuncture and manipulative techniques.

Weiner RS, ed. Pain Management: A Practical Guide for Clinicians. Boca Raton, Fla: St. Lucie Press; 1998.
Williams PL, ed. Gray's Anatomy. 38th ed. New York, NY: Churchill Livingstone; 1995.
Foundations for Osteopathic Medicine. Baltimore, Md: Williams & Wilkins; 1997:843-899.
Helms JM, Elloriaga-Claraco A, Ng A. Point Locations and Functions. Brookline, Mass: Redwing Book Co; 2002.
Guillaume G, Chieu M. Rheumatology in Chinese Medicine. Seattle, Wash: Eastland Press; 1996.
O'Connor J, Bensky D, trans-eds. Acupuncture: A Comprehensive Text. Seattle, Wash: Eastland Press; 1981:622, 626, 632, 656, 662.
Helms JM. Acupuncture Energetics: A Clinical Approach for Physicians. Berkeley, Calif: Medical Acupuncture Publishers; 1995.
AUTHOR INFORMATIONDr William H. Stager is in holistic private practice in West Palm Beach, Florida. He is Board-certified in Osteopathic Manipulative Medicine, Family Practice, Medical Acupuncture, and Pain Management.William H. Stager, DO, MS, DABMA*2617 No Flagler Dr, Suite 111West Palm Beach, FL 33407

Osteopathic Medicine and Treating the Common Flu: Use of osteopathic manual medicine aids patients in treating the flu virus


The Cranial Academy: Experts Revisit Successful Treatment in Worst Flu Epidemic in 1918 as Avian Flu Threatens

Census officials reported a startling recovery rate among patients, in the deadliest flu epidemic in history in 1918, had one thing in common: the same type of doctor.
"Traditional osteopaths" are long on evidence as the best-cited specialty in treating flu cases but short on public recognition of their non-invasive treatment -- osteopathic manual medicine (OMM). Still, the ability to help patients, osteopaths say, stems from the profession's unique training to effectively address the underlying abnormalities that cause illness, including influenza.
The point of treatment, especially in a flu virus, is to trigger the body's own natural healing mechanisms and increase immune response. "The congestion that flu causes predisposes the patient to pneumonia and sets up an environment in which the virus will proliferate," said Dr. Zinaida Pelkey, who practices OMM at St. Barnabas Hospital in New York. "By mobilizing the fluids and allowing the body's own immune system to function optimally you not only bring in cells that fight infection but clear away waste products of infection and inflammation."
Because their neuromusculoskeletal specialty falls into the category of physical medicine (hands-on treatment), the physicians and surgeons have been typically confused in the minds of their colleagues as practicing a modality in an unrelated field: chiropractic treatment.
This hasn't stopped health commissioners from making the distinction in the physicians' track record demonstrating that patients under their care experienced a shorter duration of flu, a lower incidence of pneumonia (a by-product of flu), and most important, a drastically lower mortality rate.
A study tracked 110,120 patients with influenza and determined that patients treated by osteopaths survived with a near zero, or 1/4 of 1 percent mortality rate, as compared with patients treated with conventional medications, which reported more than 20 times higher, or 6 percent mortality rate on a national average, according to U.S. Health Commissioners in 1919. The death toll was as high as 30 percent in some cities. The promise of a cure was also higher in cases of pneumonia: the death rate among patients treated with osteopathic manual medicine was 10 percent, compared to 30 percent among cases treated with conventional medications. Health commissioners collected medical records from 2,445 osteopaths treating patients in cities with populations of 40,000 or more across the country.
"The statistics are so drastically different in patients treated by osteopaths," said Dr. Pelkey. "We look at the flu today and we don't have much more to offer than people did back in 1918. We have antibiotics for infectious diseases but the flu is viral. We have some antiviral medications but they don't work for every kind of flu and may be contraindicated for some of the people at highest risk. So to have a form of medicine like osteopathy that essentially has no side effects and has been shown to be effective -- for all health conditions -- makes a huge difference."
Ironically the influenza epidemic in 1918 was recently identified as a "bird virus," a less fancy name than avian flu today. Despite the strange genetic mutation of the virus, osteopathic physicians maintain the same approach to treating dysfunction in the body caused by the illness.
Results to date are far from mixed and weighted heavily in favor of non-invasive medicine over conventional medication. There is evidence that the pendulum has also swung in the forum of public opinion, with more patients becoming interested in non-invasive treatment. Recently osteopathic medicine was cited as one of the fastest growing medical fields in the country, according to an article in the New York Times.

An Easy Way to Get Personalized Medical Care: Choose an Osteopathic Medical Physicians (D.O.s)

Source: news/atoz/article_934357.php

The Morning Read: Bringing health home
Doctor takes a personal approach to patients, hauling his office to their living rooms.

This is not your typical doctor's office. The room is dim. The air reeks of stale cigarette smoke. When you sit on the sofa, a cloud of dust rises up. And the scale on the floor is 6 pounds off.
But today, for close to an hour, Bob Price's apartment in San Clemente is a doctor's office. Norm Vinn's office, to be precise.
You don't go to Vinn. Vinn comes to you. He is one of maybe a dozen physicians in Orange County whose business is making house calls.
While your family practitioner might squeeze in 20 to 30 patients a day, Vinn sees eight. While your family practitioner might see you for 15 to 30 minutes, Vinn listens for up to an hour.
"I don't want to get too weepy here," he says over a cup of steaming coffee at a booth at Denny's, his office this morning. But trading in his family practice for the slower-paced house-call track was a chance "to find some inner peace. And spiritual fulfillment."
He was sick of always being in "too much of a hurry to ask people about the book they're reading or their families," he says.
By 9 a.m. on most days, Vinn is finished surfing Lower Trestles and is driving to his first visit in his silver Lexus.
Today he stops on a street in San Clemente, fishes a stethoscope, doctor kit and miniature lab-test machine out of his trunk and walks up to the door of Apartment A with a knock and a holler. "Bob? It's Dr. Vinn!"
Inside, Bob Price is lying on his side in bed, his skinny legs barely covered by a loose blue hospital gown. There's no bottom sheet on the mattress. His feet are bare.
"No hair, no teeth, no aorta," is how Price sums up his condition. An aneurysm blew the aorta out and he's had prostate cancer for 11 years, not to mention "two bad hips and two bad legs," scoliosis, arthritis, a cold that won't quit, a rash, congestion and a creeping cataract.
But Price is an optimist. "Eighty-five and still alive!" he laughs.
Vinn "has been a godsend," Price says.
Price doesn't have a wife or children or a car, and even if he did own wheels he can barely hobble to the bathroom a few feet from his bed, let alone drive to a doctor.
He is the prototypical house-call patient. Medicare requires that it take "significant and taxing effort" for the patient to walk 100 feet before it will pay for a house call.
Vinn's patients include a young woman who was paralyzed in a freeway wreck and a man who can't get out of bed because he weighs more than 700 pounds. But most people he treats are in their 80s, trapped in their homes because their bodies are just calling it quits.
Just as often as Vinn discusses a patient's blood pressure, he finds himself discussing their mortality. Are they ready? How are they coping? "Candid, strange conversations," he says. If dementia is present, that conversation is often with the patient's spouse or children.
Because most of his patients are facing The End, the depression factor is one of the downsides of the house-call business. It brings to his mind the axiom: When you're a hammer, everything starts looking like a nail.
So when he starts feeling like everyone is dying, he takes off his red tie and white button-down shirt, puts on a wetsuit and heads to the ocean to put things back into perspective.
Vinn opened his practice in Long Beach in 1978 and enjoyed it until managed care came along in the '80s. The turnstile of patients, he said, became "very frustrating for patients and very frustrating for the doctors."
Vinn is an osteopathic physician, which means he treats the whole person. Besides diagnosing illnesses and treating symptoms, he counsels patients on nutrition and hygiene, addresses depression and loneliness, discusses financial hardships and even connects patients with social-service agencies.
In other words, he needs more than 20 minutes.
It got to a point where he was coming home at night to his wife and three daughters, "angry, irritable, frustrated, depressed. I wondered if I was a squirrel in a cage."
In 1998 Medicare began paying doctors more equitably to make house calls, Vinn says. The next year a colleague told Vinn about a doctor who had started a house-call business in San Diego. Vinn took a chance and joined the group. In 2002 he started his own business called Housecall Doctors Medical Group.
He brought in another doctor and three nurse practitioners and opened an office in Laguna Hills, but it's only used to store charts.
Not being chained to an office has its perks, but it also has a few hassles. Vinn puts 2,500 miles a month on his car driving to patients all over Orange County. He earns about 20 percent less than when he had an office practice. He meets medical officials in parking lots to sign death certificates and gets calls from patients at all hours.
The other night, a call came during dinner from a woman who got his number from a health-care agency. Vinn told her he was eating and would be there as soon as possible. By the time he showed up at her house, she said she was having her dinner and refused to let him in.
But most of the 350 patients in his practice are so appreciative, they practically gush.
Price says he is grateful that Vinn is simply around to talk to. And Price is quite a talker.
Now he is talking about how he never considered giving up smoking because he thinks it's therapeutic for people who experience depression. Vinn sticks a flu shot into Price's arm. Then he checks his prostate.
"Thank you, sir," Price says when it's done.
"Are you eating a lot? You look to me like your face is thinner," Vinn says.
"You think you can weigh me?" Price asks. "That's a good idea, doctor."
Price swings his legs around to sit on the bed. Then, leaning on his walker, he stands and steps precariously onto an old dusty scale that the doctor brought in from the kitchen. Letting go of his walker, Price balances for a few shaky seconds to put his full weight on the scale. It reads 127 pounds.
"I weighed 185!" Price says. "Well, stranger things have happened."
"Let's try it one more time," says the doctor.
The room is dim, maybe they read it wrong. "You want a flashlight?" Price asks.
Vinn says no but steps on the scale himself to check for accuracy. It's about 6 pounds light, he decides. When Price steps back on, it still registers 127. So he's probably 133 pounds, the doctor figures.
"Oh, man. If I had any sense, I'd be scared," Price says.
Six days later Price calls an ambulance to take him to a hospital in Long Beach. He can't manage his catheter anymore. Vinn gets wind of it, rings a San Clemente rest home and asks them to hold a bed for Price so he can bring him back to Orange County.
"That way Dr. Vinn can still look in on me," Price says. "Ya know. I think everything's gonna be fine."

Wednesday, January 04, 2006

Curing Shoulder Pain Using Osteopathic Manipulative Treatment(OMT) by DOs

Source: Osteopathy/Curing_Shoulder_pain.shtml

'Doctor, I don't know what has happened to my shoulders. They ache a lot and the ache is gradually increasing. I cannot move them properly. It is becoming impossible for me to put on my clothes myself even combing has to be done by somebody else. The pain persists during the day, but at night it becomes worse. If somebody presses my shoulder joint, I get an excruciating pain. I have had all kinds of treatment but nothing seems to be helping me. Can you do something?'

The above symptoms seemed to point towards a frozen shoulder. This condition can be diagnosed easily. The shoulder joint is frozen and its mobility reduced. Before we go further let us examine what our shoulder joints are and what they do.

A shoulder joint is a ball and a socket joint. The head of the upper arm bone (humerus) and a shallow cup-like structure of the shoulder blade (scapula) make up this joint. The head is much bigger than the socket and only a part of the head can fit into the socket called the glenoid cavity. The socket is deepened by a fibrocartilagenous rim. Due to this arrangement, the shoulder has a better range of movement than any other joint in the body. But it is a weak joint and depends on the surrounding muscles for its strength.

The joint is covered by a sac-like structure, a fibrous capsule. This capsule is lax and the bones can be separated from each other for a distance upto half an inch. This can provide a further range of movement. The inferior part of the capsule is the weakest part. The movement at the shoulder joint is further increased by the movement of the shoulder blade itself When the arm is raised upto 1200, movement takes place at the shoulder joint and a further 600 is obtained by rotation of the shoulder blade. The acromio-clavicular joint at the lateral end of the collarbone (clavicle) and sterno-clavicular joint at the medial end of the collarbone also participate in shoulder movements.

In the case of a frozen shoulder, the capsule is thickened and retracted. This can be clearly demonstrated by orthography (taking an X-ray after injecting a radio-opaque dye inside the joint).

Why a frozen shoulder occurs is not known. There is a limitation of movement in all directions. It generally occurs between the ages of forty-to-sixty. After sixty, it is rare. The usual course of the disease is as follows:

It starts with an ache in the shoulder when the arm is moved. There is pain when the arm is kept still. After one month the pain is more severe and spreads down to the elbow. It is worse at night and increases further if the patient lies on the same side. Restriction of movement starts becoming obvious. After 2-3 months severe pain occurs at the slightest movement. The patient cannot raise his hand more than thirty to forty degrees. The rotative movement of the arm is also limited. After 4 months no further diminution takes place in the movement. The pain is at its worst at the end of 4 months. After 5 months it begins to reduce gradually. After 6 months there is no constant pain. Pain is felt only when the arm is moved. The patient is now able to lie on the painful side. After 7 months there is pain only in the upper part of the shoulder. After 8 months the range of movement begins to become wider. After one year the patient is almost well.

It has been noted that the pain and restriction of movement decrease during the first four months. During the next four months the pain decreases but the limitation of movement persists. In the last 4 months the range of movement returns. If exercises are done, the full range of movement is sure to return, and if no exercises are done, some amount of permanent limitation will persist at the shoulder joint.

In the severe variety, pain may go on increasing upto nine months. Wasting and thinning of muscles also start and complete recovery may take upto two years.

Some doctors advise forced mobilization under general anesthesia. Though some very good results have been achieved by this process, some grave setbacks also occur. This treatment is therefore not advisable because during this act a tear in the lower part of the capsule can occur. This has been seen by orthography taken before and after the treatment. We believe that skill and experience play a dominant role in achieving good results. It is very important to know when to stop and how to grade these maneuvers. This is practically impossible when the manipulation is done under anesthesia, because the results are only known the next day or when the patient wakes up. For such cases we recommend a gradual stretching of the shoulder without anesthesia. However this is not as simple as it sounds. If there is too much stretching, it provokes pain and if there is too little, it does not produce any results. Stretching has to be done with great care. The patient feels great discomfort when the arm reaches the restricted range; it should then be coaxed a little further without increasing the pain or producing a muscle spasm. The shoulder should be moved in this final increased range for five to seven minutes twice a week. The patient should also be taught certain exercises which should be done twice a day at home. This treatment, in my experience, reduces the recovery period to two to three months. Sometimes cervical and upper dorsal manipulation along with mobilization is helpful.
This treatment can also be given in the case of a frozen shoulder after an accident.
There are other cases where the patient feels pain in the shoulder joint, but it is radiated from the neck. In these cases, 'the shoulder is nothing, the neck is everything!' Here manipulation of the lower cervical spine brings about a spectacular recovery, and when this is so, the above diagnosis is confirmed. In these cases movement at the shoulder joint is quite free. Pain may radiate in the whole arm from the base to the neck, accompanied by numbness, a tingling sensation and a feeling of pins and needles in the hands.
The pain in the shoulder may also be caused by diseases of the thorax and abdomen.

Keeping the joint mobile is very important. This can be done at home in the following way:
1. Stand up, bend forward, leave your arm hanging loose, take it to the right as far as you can, then to the left. Then take it forward and backward. Rotate the arm clockwise and anti-clockwise. Repeat this twenty times. (Fig. 40, A & B).
2. Stand by the side of the wall, with your affected shoulder on the wall side. Now bend your arm at the elbow. Rest the forearm on a platform by the wall as high as possible. Bend your knees and slowly come down. As you come down you will stretch your shoulder up. Go down as far as you can and then come up. Repeat this twenty times (Fig. 40, C).

Case Histories

@ A fifty-five-year old man had pain in his right shoulder and his movement was restricted for five months. He had no history of injury. The pain in the right shoulder went on increasing. Along with doing exercises, he took diathermy and intra-articular hydro-cortisone injections, but nothing helped.
He came to me with this complaint. The X-ray of his shoulder joint was clear: the cervical spine showed spondylosis. The blood sugar was high. He could not raise his arm more than forty-five degrees.
Manipulative treatment was started and he was called twice a week. He was taught a few exercises to be done at home. By the end of three weeks, he could raise his arm to about 1200. Treatment continued for two months and he was ninety per cent better. He was advised to continue exercises and come fortnightly for treatment. Two months later he was completely free of pain.

@ A thirty-eight-year old man, thinly built, had a severe pain in the left shoulder radiating to the arm, with a tingling sensation in the left hand. He had had a similar attack a year before which had cleared in two months. He took anti-inflammatory drugs which gave him little relief He consulted orthopaedic surgeons and an X-ray was taken, confirming that he had spondylosis of the cervical spine.
Manipulative treatment was started. Following the treatment he had no pain for four days. He was cured after the third round of manipulative treatment.

Sunday, January 01, 2006

Cervical Mobilization in Post Traumatic Headache/Cervicalgia

Source: alt-med/altmedlib_cervmob.html

By Sherman Gorbis, DO, FAAO

All osteopathic physicians, in their first two years of osteopathic medical college training, are taught Osteopathic Palpatory Diagnosis and Osteopathic Manipulative Treatment (OMT). OMT is one type of manual medicine. OMT is defined as “The therapeutic application of manually guided forces by an osteopathic physician to improve physiologic function and/or support homeostasis that have been altered by somatic dysfunction” (1). Somatic dysfunction is defined as “Impaired or altered function of related components of the somatic (body framework) system: skeletal, arthrodial, and myofascial structures, and related vascular, lymphatic, and neural elements.” Somatic dysfunction is treated using OMT (1).

The diagnostic triad for diagnosing somatic dysfunction is ART:
Asymmetry-determined visually and by palpation
Restriction of motion-determined by palpation
Tissue texture abnormality-determined by palpation

Traumatic cervicalgia (neck pain) can occur as a result of a motor vehicle accident (commonly during/after a whiplash injury where the head and neck are thrown forward/backward), sports related injury, or a fall (such as from a ladder, horse, etc).

It would be very common and not un-expected for the patient who has experienced trauma to have Post Traumatic Headache/Cervicalgia (neck pain) with accompanying somatic dysfunction in her/his cervical spine (bones that make up the neck). The cervical spine is divided into two regions based on their motion characteristics:

Atypical cervical vertebrae. This includes C0-C2 (the upper surface of C2). C0 is the occipital bone, which is located in the lower back area of the skull. The occiput articulates (joined together to allow motion between them) with the first cervical vertebra, C1. C1 articulates with the second cervical vertebra, C2. Several muscles that have attachments in the cervical spine, or below, also attach to the occiput. When these muscles become hypertonic (a sustained contraction but not a spasm (as with a ‘charley horse'), headache can occur. If restriction of motion is present between vertebrae, due to a disruption in the motion of the facets (small joints between the vertebrae which have pain generators) neck pain and headache can occur.
The headache may also result from irritation of the right and/or left greater occipital nerve. This travels through the articulation between the occiput and the first cervical vertebra. It then travels up behind the ear and forward along the temple.

Typical cervical vertebrae.
This includes C2-T1 (the lower surface of C2-the upper surface of T1). As above, both muscle hypertonicity and motion restriction can lead to headache and neck pain
Once a physician evaluates the patient who has been involved in trauma and he/she has determined that no contraindications (special conditions that render the use of the procedure inadvisable, usually due to risk) exist for manual medicine, the manual medicine provider then has several options.

Various types of OMT include:
Soft tissue. This refers is directed toward tissues other than bone or joints (1).

Muscle energy. The patient voluntarily moves the body as specifically directed by the operator; this is from a precisely controlled position against a defined resistance by the operator (1). Muscle energy is, for the most part, directed at loosening tight muscles using isometric (the muscle does not shorten during the contraction) contractions of the affected muscles. It is also directed at providing proper motion of the facet joints between the vertebrae. Facet joints are located both on the inferior and superior surfaces of vertebrae to allow one vertebra to move freely in relation to the vertebra below. Muscle energy techniques can treat facets that are either dysfunctionally ‘opened' or ‘closed'.

Direct Action Thrust (Mobilization with Impulse). Uses a high-velocity/low-amplitude activation, or thrust, to move a joint that is experiencing somatic dysfunction to help restore appropriate physiologic motion (1). This can be, sometimes, accompanied by an audible ‘click' or ‘pop'. However, the goal of treatment is the restoration of motion, not the presence of the sound.
Myofascial Release. This approach engages continual palpatory (the provider's hands in contact with the patient) feedback to achieve release of myofascial (muscles and their soft tissue/fascial coverings) tissues. This can be employed when tissue hypertonicity is present without severe motion restriction.

Other types of OMT include functional indirect and cranio-sacral.

Many insurance companies cover OMT and many osteopathic physicians who include OMT in their practices accept these plans. It is always helpful for the patient to inquire with his/her insurance company, as well as the provider, regarding coverage.

Ward RC, exec. ed. Foundations for Osteopathic Medicine 2 nd ed. Philadelphia : Lippincott Williams & Wilkins, 2003.American Academy of Osteopathy (AAO) This group's mission is to teach, advocate, advance, explore, and research the science and art of osteopathic medicine, emphasizing osteopathic principles, philosophy, palpatory diagnosis and OMT in total health care. Most, if not all, members use OMT in some degree in their practices. Phone (317) 879-1881 Fax (317) 879-0563 www.academyofosteopathy.orgAmerican Osteopathic Association (AOA) Patients can inquire about educational materials regarding OMT.
Sherman Gorbis, DO, FAAO is a graduate of the Kansas City (MO) College of Osteopathic Medicine . He interned at Riverside Osteopathic Hospital ( Trenton , MI ). He earned his certification in Osteopathic Manipulative Medicine (OMM) in 1991 and his Fellowship in the American Academy of Osteopathy (FAAO) in 1995. He is presently an Associate Professor in the Department of OMM at Michigan State University College of Osteopathic Medicine ( East Lansing , MI ).

Treating a Whiplash with Osteopathic Manipulative Treatment(OMT)

Source: thr_report.cfm?Thread_ID=232&topcategory=Neck

Imagine yourself driving when a car behind you rear-ends your vehicle. The impact pushes your car forward. It takes about 100 milliseconds for your body to catch up to the forward movement. Your shoulders travel forward until they are under your head, and your neck extends forward as your head tilts slightly down toward your steering wheel. You step on the brakes, bringing the car to an abrupt halt. The sudden stop throws your head and neck backward, and they bounce against the headrest. In a matter of seconds, you've experienced the classic mechanism of injury for whiplash.

About 20 percent of people involved in rear-end collisions later experience symptoms that center in the neck region. Although most of these people recover quickly, a small number develop chronic conditions that result in severe pain and sometimes disability.

Signs and symptoms

People who experience whiplash may develop one or more of the following symptoms, usually within the first two days after the accident:

Neck pain and stiffness
Pain in the shoulder or between the shoulder blades
Low back pain
Pain or numbness in the arm and/or hand
Ringing in the ears or blurred vision
Difficulty concentrating or remembering
Irritability, sleep disturbances, fatigue

Diagnosis and Treatment

How whiplash injuries occur is clearly understood, but the extent and type of injuries varies greatly. The diagnosis of whiplash is often one of exclusion. Most injuries are to soft tissues such as the disks, muscles and ligaments, and cannot be seen on standard X-rays. Your doctor may need to request specialized tests, such as computed tomography scans or magnetic resonance imaging (MRI).

In the past, whiplash injuries were often treated with immobilization in a cervical collar. However, the current trend is to encourage early movement, rather than immobilization. The soft collar may be used for a short term and on an intermittent basis.

Ice may be applied for the first 24 hours, followed by gentle active movement. Your doctor may provide you with a series of exercises that you can do at home. An early return to work is encouraged, even if your doctor must prescribe some temporary modifications in your work situation. No single treatment has been scientifically proven as effective, but pain relieving medications, exercises, physical therapy, traction, massage, heat, ice, injections and ultrasound have all been beneficial for some patients.

As soon as possible, you should begin aerobic activities, such as walking. Your doctor may prescribe some isometric exercises as your condition improves. Symptoms resolve within several months for about 75 percent of people who have whiplash. Chronic conditions should be investigated further and might require surgery.

Where OMT comes in handy.....

OMTs can be applied to a variety of health problems, both musculoskeletal and non-musculoskeletal. According to the US Department of Health and Human Services, OMTs are most effective for back and neck pain. In fact, if you have back pain, you may be able to reduce the amount of pain medication you are taking if you receive OMT as part of your therapy. One study showed that patients with pancreatitis were able to go home from the hospital sooner when they had OMT.

In one small study, people with Parkinson's disease were able to walk better after only one session of OMT. Another study looked at 38 patients who had knee surgery. Those who had OMT were able to walk up stairs 20% earlier than those who did not have OMT.

A study of 100 people with high blood pressure treated only with OMT showed that OMT produced significant reductions in blood pressure.
Studies show that OMT eases breathing, drains the sinuses and relieves the symptoms, duration, and recurrence of the common cold.
Osteopathy may also be an effective way to treat carpal tunnel syndrome. More studies are needed to confirm this.

Examples of other conditions for which OMT may be helpful include:

stress-related problems (such as tension headaches, muscle spasm)
strains and sprains (especially of the neck and back)
shoulder pain
painful menstruation
injuries (such as whiplash)
scoliosis (side to side curvature of the spine)
infantile colic

Osteopathic study: Treatment cuts pain

Source: PCOM News Release

The Philadelphia College of Osteopathic Medicine has produced what it is calling the first study that provides "objective data" demonstrating how osteopathic manipulative treatment, or OMT, can reduce pain after surgery.

OMT focuses on learning the body's interconnected system of nerves, muscles and nerves, and understanding how an injury or illness to one part of the body can affect another. Doctors in osteopathic medical schools are taught how to use their hands to diagnose injuries and illness, and how to manipulate the musculoskeletal system to encourage the body's natural tendency to heal itself.

The PCOM study, led by Dr. Frederick Goldstein, involved 33 hysterectomy patients at City Avenue Hospital who were all unfamiliar with OMT.

Researchers measured the amount of morphine that was required to treat pain, and the patients' perception of the pain levels, following the surgical procedure.

The study contained two variables. Some patients received morphine prior to surgery and others received a saline solution. After surgery, certain patients from each group received OMT while the others got "sham OMT," where a doctor placed his or her hands on specific areas of the patients, but did not perform any manipulation.

The preliminary results of the study showed OMT had a greater effect than drugs in reducing post-operative pain, and that the osteopathic treatment worked to reduce pain regardless of whether the patients received morphine or saline prior to surgery.

"This study is breakthrough scientific proof that OMT has a crucial role in treating patients who are in pain," Goldstein said.

Goldstein and his team plan to release additional study results within the next six months.

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