Introduction to
Osteopathic Medicine
Ronald Januchowski, D.O.
Associate Dean, VCOM
Objectives
Review the history of Osteopathic
Medicine
 Introduce / review some common
techniques
 Practical applications

History of Osteopathic
Medicine

Some dates

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1874 – basic principles first articulated by
A.T. Still, M.D.
1892 – first college founded in Kirksville,
Missouri
1950 – start of full practice rights
1967 – draft extends to D.O.
1973 – full practice rights in all 50 states
History of Osteopathic
Medicine

Basic tenets of Osteopathic Medicine

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The body is a unit, and the person represents a
combination of body, mind, and spirit.
The body is capable of self-regulation, self-healing,
and health maintenance.
Structure and function are reciprocally interrelated.
Rational treatment is based on an understanding of
these principles: body unity, self-regulation, and the
interrelationship of structure and function
History of Osteopathic
Medicine

Evolution of mission and identity
Year
Identity or mission
1892-1950
Manual Medicine
1951-1972
Family Practice / manual therapy
1973 – present
Full service, multispecialty care
History of Osteopathic
Medicine – Growth
FIRST YEAR
ENROLLEMENT
IN D.O.
SCHOOLS
History of Osteopathic
Medicine – Growth

Medical schools in the U.S.
34 D.O. schools
 137 M.D. schools

History of Osteopathic
Medicine – % by state
Location of osteopathic medicine schools are shown in red
% of physicians in state <3%
3-5%
5-10%
10-15%
15-25%
History of Osteopathic Medicine
D.O. vs. M.D.’s
D.O.

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4 years of medical school
Residency training
Licensing exam
Unlimited medical practice
Use of Osteopathic
Manipulative Treatments in
addition to medicines and/or
surgery
M.D.
 4 years of medical school
 Residency training
 Licensing exam
 Unlimited medical
practice
 Use of medicines and/or
surgery
History of Osteopathic Medicine
D.O. vs. Chiropractors
D.O.
 4 years of medical school
 Manipulation as one
method of many
treatment methods
 Fully licensed, unlimited
practice physicians
Chiropractic Medicine
 4 years of chiropractic
school
 Use of spinal adjustment
is main method of
treatment
 Limited practice licensure
Terminology - Diagnosis

Somatic dysfunction
Impaired function of the body
framework
 Treatable using OMT
 Described using

• Position of the part
• Direction which motion is best or limited
• TART
Terminology - Treatment
Soft tissue techniques
 Effluerage / lymphatic techniques
 Counterstrain
 Muscle Energy
 HVLA

Terminology – Treatment

Soft tissue stretching
Lengthening linear/band muscles
 Gentle technique
 Can be performed on acute injuries

Terminology - Treatment

Effleurage
Gentle technique
 Improves lymphatic flow
 Reduces sympathetic tone to the area


Lymphatic pump
Generally gentle
 Improves lymphatic flow

Terminology – Treatment

Counterstrain
Gentle technique
 Find a dysfunction and place the area
in a position of comfort
 Hold for 90 seconds and return to
neutral position

Terminology - Treatment

Muscle Energy
Take dysfunction to barrier
 Resist movement away from barrier
 Repeat
 Works for small or large areas
 Gentle technique

Terminology - Treatment

High Velocity Low Amplitude (HVLA)
Takes an area of dysfunction to a
barrier
 Thrusting through the functional
barrier to improve movement

Headaches in History
Headaches in History
Headache Types

Primary
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Migraine (with and without aura) headache
Tension-type headache
Cluster headache
Secondary
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Sinus related
Vascular (AVM, aneurysm)
Post trauma
Structural or metabolic derangements
Exam findings

Structural exam findings
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C1-C3 somatic dysfunction
Tender points in particular headaches
• Frontal & orbital (C1, occipitomastoid)
• Periorbital (C2, occipitomastoid, infraorbital and nasal)
• Occipital (C4)
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Motion restrictions in OA area
Scapular / upper thoracic dysfunction
Sacral dysfunction sometime involved
Acute Treatment Plan
Treat rapidly
 Restore patient’s function
 Optimize self-care
 Minimize side effects

Acute Treatment – TTH
Aspirin
 Acetominophen
 NSAIDs

Ibuprofen, Ketoprofen, Naproxen
 Ketorolac

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Combinations with caffeine
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Excedrin Migraine, Advil Migraine
Acute Treatment – TTH

Butalbital or codeine combos
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Triptans, Muscle relaxants


Not recommended for general patients because
of side effects and/or overuse
May be used in patients who cannot use to other
meds (pregnancy, renal failure)
Not effective in pure TTH
Other methods

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OMT
Ice, biofeedback
Preventive Treatment – TTH

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Amitriptyline
SNRIs
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Mirtazipine
Venlafaxine
SSRIs – no benefit over placebo
Anticonvulsants – limited data

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Gabapentin
Topiramate
Preventive Treatment – TTH
Tizantidine – limited studies
 Botulinum toxin – no effect over placebo
 Behavioral therapy – limited studies
 Physical modalities

Spinal manipulation / OMT was less effective
than Amitriptyline for initial pain, but had
better lasting effect and less side effects
 Craniocervical exercises effective

Osteopathic techniques for
headache treatment

Soft tissue techniques

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Counterstrain

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OA / Cervical
Muscle Energy
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OA / Cervical Spine / rhomboids
Scalenes
HVLA

Lumbar roll
Questions?