4/19/2012
MANIPULATING THE MATURE
Brian Mulroy, D.O.
Spartanburg Regional Healthcare System
VCOM Carolinas Clinical Instructor
May 5, 2012
OBJECTIVES
Review anatomic and physiologic changes in the
“mature” population
 Thinking through the OMT process
 Review common clinical scenarios and
appropriate OMT for a busy clinical practice

THOUGHTS
Prevention and maintenance
Mature patients may need a longer duration of
time for an appropriate response (but not all)
 Older patients tend to respond well to indirect
techniques and direct techniques such as
articulation
 “As the individual ages, the ability to compensate
for stress decreases, while physiologic sources of
stress increase3”
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4/19/2012
THOUGHTS CONTINUED…
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Posture: how does it play a role in mobility and
safety?
Vision
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Cataracts
Cervical flexion and its effect
Develop your game plan
Treat thoracics before ribs and cervical spine
Treat axial spine before extremities
 My general approach:
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Thoracics/ribs
Cervical
Lumbar/psoas/piriformis
Pelvis
Sacrum
Extremities
AGING
Determined by genetic factors, lifestyle choices,
and environmental exposures
 Anatomic changes

Decreased bone density
Loss of disk spaces
 Changes in posture


AGING CONTINUED

Physiologic changes

Decreased immune function

Cytokine profiles consistent with a chronic, low-level
inflammatory state
Less variability in heart rate responses
Altered circadian patterns
 Loss of physiologic reserves

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Bone marrow, glycogen, etc.
Decreased renal and hepatic function
 Vision (presbyopia due to changes in the lens and
iris)
 And many more…
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4/19/2012
POSTURE

Exaggerated kyphosis
Myofascial release
Springing
 Counterstrain
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Pelvis
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Off because they favor one knee over another?
Quads and hamstrings balanced?
OSTEOARTHRITIS
PIP and DIP joints
Spencer technique for shoulder
 Cervical spine
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Soft tissue
Articulation
 Counterstrain (anterior and posterior)
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CERVICAL TENDERPOINTS
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4/19/2012
VENOUS INSUFFICIENCY

Venous insufficiency
of the lower
extremities
Thoracic outlet
Abdominal diaphragm
 Pelvic diaphragm
 Popliteal fossa
 Pedal pump


WRAP UP

Teaching patients to treat themselves at home
Every patients gets stretching and strengthening
exercises!
 Yoga, Pilates, Tai Chi

REFERENCES
1)
2)
3)
4)
CCOM Faculty. Osteopathic Manipulative
Medicine. OMM/CCOM Procedure Manual.
2006.
Kimberly, Paul. Outline of Osteopathic
Manipulative Procedures. 2008.
Nelson, K.E., Gloneck, T. Somatic Dysfunction
in Osteopathic Family Medicine. 2007. Pages
159-180.
Savarese, R.G. OMT Review. 3rd Edition.
2003.
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