L2: Principles and Practice

Question 1

Philosophy vs principle. Applicability of this to osteopathic medicine?

Answer 1

• Philosophy: inquiry into nature of things based on logical reasoning rather than empirical methods. Gained by pursuit of wisdom through intellectual means, no by lab analysis. - Principle: rules or laws concerning functioning of natural phenomena or mechanical process. Can be proved by experimental design or lab analysis. - Osteopathic tenets are philosophies, not principles, since they are based on logical reasoning rather than on experimental design.

Question 2

How is SD incorporated into the clinical picture?

Answer 2

• the physician must view the clinical presentation (illness) as a combination of factors and not just a disease; the disease is almost always combined with a somatic dysfunction in the host; the host’s response to illness (SD) plus the disease is what forms the complete clinical presentation

Question 3

What is the definition of somatic dysfunction (SD)? How is it diagnosed?

Answer 3

• Defined as impaired or altered function of related components of body framework system including skeletal, arthrodial and myofascial structures including their related vascular, lymphatic and neural elements. Defined as a musculoskeletal restriction in motion that affects the patient’s function. It is what OMM is designed to find and relieve. - This is diagnosed through observation, palpation for TART: tenderness, asymmetry, restriction of motion and tissue texture abnormality

Question 4

Explain the philosophical aspects of osteopathic medicine including the early thoughts and evolution of osteopathic thinking:

Answer 4

• AT Still was convinced that 19th century medicine was inadequate (lost 3 children to spinal meningitis. - Set himself on discovery to find other methods for curing and preventing disease. Studied anatomy repeatedly - He noted relationship between structures and function of the body in health and disease - Experimented with manipulation, found this provided better results that drugs being used at the time - Practiced pt education, surgery and midwifery, but believed in moderation and avoidance of certain practices - Treated his own headache via suboccipital tension release - Abnormal anatomic state leads to physiologic breakdown leads to decreased host adaptability = disease; combined with adverse environmental conditions = worsening disease - Eg. Recognized that symptoms were manifestation of artery not delivering sufficient blood to area, leading to decreased function of that area and then disease - Eg. Blood vessel controlled by nerves can be irritate by a wrong position of bone or ligament - Eg. Accumuluation of fluids from poorly controlled drainage (veins/lymphatics) further exacerbates/leads to congestion/inflammation and poor function, pathology (disease) - We can affect nerves that control vessels or vessels themselves by knowing anatomy and physiology by using hands to remove obstructions, restoring health - Reason, according to AT Still, and facts, not opinion, are key to the osteopathic philosophy. Students were to study, test and improve on ideas.

Question 5

What are the osteopathic tenets? Explain each

Answer 5

• developed by KCOM, they are: 1. the body is a unit; the person is a unit of body, mind, and spirit - eg. Pain in body can affect thinking, emotions and function. Anxiety and nervousness can increase tension in muscles. Sometimes it can be severe enough to cause stomach disease, intestinal disease and myofascial pain. Stress can lead to headaches, chronic pain. - Muscles are organs of emotion, cannot show a single emotion without moving a muscle 2. the body is capable of self-regulation, self-healing, and health maintenance - the Dr. does not cure, but simply pushes towards healing - Eg. Surgery would not work if this wasn’t the case, fractures heal when bones are close to each other, body has ability to regrow atrophied muscles when nerves are relieved with OMM, theraphy or surgery 3. structure and function are reciprocally interrelated - dysfunction in the organ can have effects in somatic areas (somato-visceral reflexes) and somatic dysfunction in a particular somatic area can lead to dysfunction in another somatic area (somato-somatic reflexes). - Eg. T5-T9 on left affects function of stomach (viscerosomatic reflex); C5 innervates and affects function of Rhomboids (somato-somatic reflex) 4. rational treatment is based upon an understanding of the basic principles of body unity, self-regulation, and the interrelationship of structure and function. - Rational treatment includes OMM. If not, then regular medicine is being practice. Regular medicine is not; however, irrational, it is just osteopathically incomplete. - Eg. Pinched nerve in neck leading to arm pain and atrophy. OMM used to balance dysfunctioning vertebrae and separate them with manual traction. Opposition to surgery and medicine only. - Eg. Abdominal pain and ulcers. Regular medicine used medicines only, no relief. OMM treatment for 1 month. Medications needed sporadically after.

Question 6

What is the definition of OMM?

Answer 6

• Defined as the manual treatment of abnormal structure found in the musculoskeletal system for the purposes of restoring proper function in the human body