Pediatric Scoliosis OMT Module


American College of
Osteopathic
Pediatricians
Robert Hostoffer,
DO,FACOP, FAAP
edited by
Eric Hegybeli, DO,
FACOP
Background:
Andrew Taylor Still, was born in Virginia in 1828, the son of a
Methodist minister and physician. At an early age, Still decided to
follow in his father's footsteps as a physician. After studying medicine
and serving an apprenticeship under his father, Still became a licensed
M.D. in the state of Missouri. Later, in the early 1860's, he completed
additional coursework at the College of Physicians and Surgeons in
Kansas City, Missouri. He went on to serve as a surgeon in the Union
Army during the Civil War.
Background:

After the Civil War and following the death of three of his
children from spinal meningitis in 1864, Still concluded that the
orthodox medical practices of his day were frequently
ineffective, and sometimes harmful. He devoted the next ten
years of his life to studying the human body and finding better
ways to treat disease.
Background:
His research and clinical observations led him to believe that the
musculoskeletal system played a vital role in health and
disease and that the body contained all of the elements needed
to maintain health, if properly stimulated. Still believed that by
correcting problems in the body's structure, through the use of
manual techniques now known as osteopathic manipulative
treatment, the body's ability to function and to heal itself could
be greatly improved. He also promoted the idea of preventive
medicine and endorsed the philosophy that physicians should
focus on treating the whole patient, rather than just the disease.
 http://www.aacom.org/OM/history.html
Toddler and Children OMT
Classification of Scolosis

Nonstructural scoliosis
– postural scoliosis
– compensatory scoliosis
Transient Structural Scoliosis
–
–
–
sciatic scoliosis
hysterical scoliosis>
inflammatory scoliosis
Structural Scolosis
–
–
–
–
–
–
idiopathic (70 - 80 % of all cases)
congenital
neuromuscular
 poliomyelitis
 cerebral palsy
 syringomyelia
 muscular dystrophy
 amyotonia congenita
 Friedreich's ataxia
neurofibromatosis
mesenchymal disorders
 Marfan's syndrome
 Morquio's syndrome
 rheumatoid arthritis
 osteogenesis imperfecta
 certain dwarves
trauma
 fractures
 irradiation
 surgery
Types of Curves
Cobb’s Angle
Vertebral Maturation
Maturation of iliac crest
Osteopathic Considerations
Type II (non-neutral) mechanics occur at the
transitional areas between the spinal curves
In scoliosis, flexed vertebral dysfunctions are
typically found in the lumbar region; extended
dysfunctions in the thoracic region
Scoliosis usually is not secondary to a short leg
Osteopathic Considerations Treatment
*Infantile scoliosis can be treated fairly effectively by
addressing the occiput (usually with cranial),
cervicothoracic and sacroiliac areas
*Treatment of older patients is focused on mobilizing
restricted areas with OMT, stretching tightened
tissues on the convex side, strengthening weak
muscles on the concave side and correcting posture
Shoulder Leveling
Demonstrate the procedure on
patient in front of director
Scapular leveling
Demonstrate the procedure on
patient in front of director
Pelvic Leveling
Demonstrate the procedure on
patient in front of director
Spinal Inspection
Demonstrate the procedure on
patient in front of director
Bending Test
Demonstrate the procedure on
patient in front of director
Innervation Table
Organ/System
EENT
Parasympathetic
Sympathetic
Ant.
Chapman's
Post.
Chapman's
T1-T4
T1-4, 2nd ICS
Suboccipital
Heart
Cr Nerves (III, VII, IX,
X)
Vagus (CN X)
T1-T4
T3 sp process
Respiratory
Vagus (CN X)
T2-T7
T1-4 on L,
T2-3
3rd & 4th ICS
Esophagus
Vagus (CN X)
T2-T8
---
T3-5 sp
process
---
Foregut
Vagus (CN X)
T5-T9 (Greater Splanchnic)
---
---
Stomach
Vagus (CN X)
T5-T9 (Greater Splanchnic)
Liver
Vagus (CN X)
Gallbladder
T6-7 on L
T5-T9 (Greater Splanchnic)
5th-6th ICS on
L
Rib 5 on R
Vagus (CN X)
T5-T9 (Greater Splanchnic)
Rib 6 on R
T6
Spleen
Vagus (CN X)
T5-T9 (Greater Splanchnic)
Rib 7 on L
T7
Pancreas
Vagus (CN X)
Rib 7 on R
T7
Midgut
Vagus (CN X)
T5-T9 (Greater Splanchnic), T9T12 (Lesser Splanchnic)
Thoracic Splanchnics (Lesser)
Small Intestine
Vagus (CN X)
T9-T11 (Lesser Splanchnic)
Ribs 9-11
T8-10
Tip of 12th Rib
T11-12 on R
Appendix
Hindgut
Ascending Colon
Transverse Colon
T12
Pelvic Splanchnics (S24)
Vagus (CN X)
Vagus (CN X)
Lumbar (Least) Splanchnics
T9-T11 (Lesser Splanchnic)
T5-6
---
---
---
--T10-11
T9-T11 (Lesser Splanchnic)
R Femur @
hip
Near Knees
L Femur @ hip
T12-L2
Descending Colon
Pelvic Splanchnic (S2-4)
Least Splanchnic
Colon & Rectum
Pelvic Splanchnics (S24)
T8-L2
---
---
---
Print out the answer sheet to use
with the following questions.
Circle the correct answer and review
with director:



Question1: A, B, C, D, E.
Question2: A, B, C, D, E.
Question3: A, B, C, D, E.
Question:

1. Inflammatory Scoliosis is considered a:
A. Transient scoliosis
B. Structural
C. Idiopathic
D. Neurogenic
E. NonStructural

2. All of the following are causes of
structural scoliosis except:
A.
B.
C.
D.
E.
Wedge vertabrae
Hemivertebrae
Congenital Bar
Block vertebra
Circular wedge

3. All are curves found in scoliosis except:
A. Thoracic curve
B Cervico/thoracic curve
C. Lumbar curve
D. Double major curve
E. Thoraco/lumbar curve
Certificate of Completion
I, _________________________,
successfully completed the Pediatric OMT
Module on __ __ 20__
Signatures:
 Pediatric Resident ____________________
 Pediatric Residency Director____________


( Please print and give to program director.)
Congratulations