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We are back....we will be adding a lot more Osteopathic Medicine content.

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What is kyphosis?

Kyphosis is the forward curve in the middle of the spine, near the ribs. Here, the spine curves slightly outward, giving the back a gently rounded look. The normal range for this curve is 20 degrees to 50 degrees.

While some rounding is normal, doctors use the term kyphosis to refer to curves that are out of the usual range. You may also hear doctors call this hyper-kyphosis.

In children as well as adults, kyphosis can cause a humpback look. It can also be painful. In more serious cases, kyphosis can cause problems in the heart and lungs. It may make it more likely that your child will one day develop arthritis in his back.

OMT Guru - The Real DO and Osteopathic Medical Blog

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You may want to bookmark this URL because this is the permanent new home of the OMT guru blog. We have moved from SDN and have established our own server.

Over a 1000 blogs are coming soon. Stay tuned.

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Osteopathic medicine goes to China

What is an osteopathic physician (DO)?

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Understanding and Treating Chronic Fatigue Syndrome and Fibromyalgia

This article provides an overview of Fibromyalgia and Chronic Fatigue Syndrome, including information about symptoms and homeostasis (self-healing).

"The most commonly accepted definition (devised by the American College of Rheumatology in 1990) is that the person affected needs to show a history of widespread pain (pain is considered widespread when all of the following are present: pain in the left side of the body, pain in the right side of the body, pain above the waist and pain below the waist. In addition there should be pain in the spine or the neck or front of the chest, or thoracic spine or lower back) and pain in 11 of 18 tender point sites on finger pressure."

Basic Symptoms of Fibromyalgia

Multiple tender areas (muscle and joint pain) on the back of the neck, shoulders, sternum, lower back, hip, shin, elbows, knees.
Fatigue
Sleep disturbances
Body aches
Reduced exercise tolerance
Chronic facial muscle pain or aching

"Both Chronic Fatigue Syndrome and Fibromyalgia often seem to begin after an infection or a severe shock (physical or emotional), and the symptoms are very similar. The only obvious difference seems to be that for some people the fatigue element is the most dominant while for others the muscular pain symptoms are greatest. In other words for many people the diagnosis Chronic Fatigue Syndrome and Fibromyalgia are interchangeable terms, although there are certain symptoms (fever, swollen glands for example) which are found in a higher percentage of Chronic Fatigue Syndrome patients than those with Fibromyalgia, which sometimes make such a comparison less precise."


Treatment:

Osteopathic treatment is based on the premise that restricted movement in the spine may lead to reduced function and pain. Spinal adjustment (manipulation) is one form of therapy a chiropractor uses to treat restricted spinal mobility. The goal is to restore spinal movement and, as a result, improve function, decreasing pain. Manipulation does not need to be forceful to be effective. A osteopathic physician may also use soft tissue massage in the treatment of FMS, stretching muscles that are shortened or in spasm.

You may also consider:

Diet And Nutrition

A natural Fibromyalgia Treatment and balanced fibromyalgia nutrition diet can be helpful in counteracting stress, removing toxins from the body, and restoring the natural balance of nutrients. Homeopathy medicine, FIBRO-HELP products, help patients by combatting stress, replacing deficiencies, and supporting the immune system. Patients are recommended to limit the amount of sugar; caffeine; alcohol; and fried, processed, fatty foods consumed. These substances have been shown to irritate muscles and stress the system increasing FM pain. Even for those patients who do not have severe food triggers or allergies, eating a healthier diet can have long-term benefits in the treatment of fibromyalgia. Supplementing the present diet with greater quantities of raw or lightly cooked fruits and vegetables, and substituting meats that are high in fat with fish or lean poultry, are also beneficial practices.

Exercise
Fibromyalgia Exercise is one of the most powerful remedies in the treatment of fibromyalgia. Increasing scientific evidence has shown that exercising for a minimum of 20 minutes per day will help fibromyalgia patients as a natural fibromyalgia treatment. Exercise becomes a key component in healing FM Syndrome patients because a properly designed routine will improve the body tissues, decrease pain, and increase mobility. The fibromyalgia exercise program must be slow and gradual. The goal is to improve overall health while decreasing FM symptoms.

Homeopathy

The word Homeopathy (or Homoeopathy) is derived from the Greek words “homoios”, meaning “like” or “similar”; and “pathos”, meaning “suffering” or ”disease”. Homeopathy is a system of medical therapeutics for treating based on the principle of “similae” or “simile.” “Disease is eliminated through remedies able to produce similar symptoms.” The principle is that certain substances (herbs, minerals, inorganic salts, and other organic materials, etc.) in full strength yield the same symptoms as does a known disease, and that those same substances when "potentised" (or diluted and vigorously agitated) can provide relief of those same symptoms. Titrated dilutions and succussions of a particular substance can often be the means for fibromyalgia treatment. Today, unlike nutritional substances, Homeopathy substances are considered medicines, recognized as powerful entities which allow specific medical claims to be made about them.

Massage Therapy

Massage involves the use of different manipulative techniques to move the body's muscles and soft tissues. Massage Therapy aims to improve circulation in the muscle, increasing the flow of nutrients, eliminating waste products. Massage can relax muscles, improve range of motion in the joints, and increase the production of the body's natural painkillers. It often helps relieve stress and anxiety for those afflicted with the symptoms of pain.

Physiatry

Physicians who specialize in Physical Medicine and Rehabilitation are called Physiatrists. Doctors of Physiatry specialize in the diagnosis and treatment of patients in 3 major areas of medical care: musculoskeletal injuries and pain syndromes, Electrodiagnostic Medicine, and rehabilitation of patients with severe physical impairments.

Physiotherapy

Physical Therapy is a health care profession that helps the patient restore the use of muscles, bones, and the nervous system. The basics of the physical therapy profession include the use of modalities like ice, heat, ultrasound, and electrical stimulation. Therapeutic exercises, therapeutic massage, manual therapy, and hydrotherapy-aquatic therapy are all used for pain relief and fibromyalgia treatment.

Self Care

Self Care is critical in the treatment of Fibromyalgia Syndrome. Some important tips for self care:

• Reduce Stress - Avoid or limit overexertion and emotional stress. Allow time to relax daily practicing stress reduction techniques such as deep-breathing exercises or meditation for FMS treatment. Sleep - Fatigue is one of the major symptoms of FM, getting enough sleep is essential. In addition to allotting enough time for sleep, get into a routine of sleeping and waking up at the same hour each day. Take short naps to restore energy in the body. Fibromyalgia Exercise - Regular exercise will help improve chronic pain symptoms. Stretching, optimum posture techniques, and relaxation practices are also helpful.

• Pacing - Keep a balance on daily activities. If too much is done on a good day, take time off the following day, and rest to avoid bad days.

• Nutrition and Healthy Lifestyle - Eat a balanced diet, limit caffeine and alcohol intake, get plenty of rest, exercise regularly, and do a leisure activity which is enjoyable and fulfilling as a complete FIBRO treatment.

Osteopathic manual medicine technique: Strain /Counterstrain Technique Development

"If You listen to the body it will tell you all you need to know!"
L. H. Jones D.O.


Strain Counterstrain is an Osteopathic manual medicine technique. It emphasizes correction of abnormal neuromuscular reflexes rather than simply addressing painful, postural or structural problems. Counterstrain recognizes that these structural, postural and painful problems are a result of the abnormal reflexes. Until these abnormal neuromuscular reflexes are addressed significant healing is difficult.

Dr. L.H. Jones initially discovered Strain Counterstrain accidentally while trying to achieve a successful treatment of a patient suffering from psoasitis. He was able to help this patient by simply applying a position of comfort for a short period of time while the patient remained passive.

It was approximately 2 years later that a second experience with this new technique helped him to understand the meaning of tender points. These are extremely useful findings in somatic dysfunctions.

Tenderpoints are manifestations of somatic dysfunction much as are the other TART changes. TART changes are seen as tissue Texture changes, Asymmetry, altered Range of motion, and Tenderness. The tenderpoint is a discrete pea sized area of tenderness that is uniquely a part of a somatic dysfunction. Each tenderpoint is a manifestation of a specific abnormal reflex that allows the practitioner to fashion a specific treatment for each patient.

Dr. Jones developed a whole system based on understanding the tenderpoint. It is a unique finding with Strain/Counterstrain that the tenderpoint is found in the shortened muscle group, not in the muscle groups that most commonly present with pain. The treatment is achieved by placing a mild over stretching on the painful muscle thereby shortening the truly dysfunctional muscle group allowing for a reset of this abnormal reflex to a normal level.

For more information see Jones Strain/CounterStrain, by L.H. Jones DO, Randall Kusonose PT, and Edward K. Goering DO.
Published by Jones Strain/Counterstrain Inc.

Dr. Jones worked within the osteopathic and physical therapy profession to develop a coherent method to teach and standardize Strain/Counterstrain techniques. Strain/Counterstrain is considered one of the primary osteopathic manual medicine techniques and as such is taught in all the osteopathic schools worldwide. The American Academy of Osteopathy and the Jones Institute offer courses throughout the United States for qualified health care professionals. Please see course page for more information.

You were wondering ...What is the difference between a D.O. and an M.D.?

You were wondering ...


What is the difference between a D.O. and an M.D.?

It's more than just a bunch of letters. Doctors of osteopathy, better known as D.O.s, are licensed physicians just like their M.D. -- medical doctor or allopathic -- colleagues. The difference lies in their approach. Osteopathic medicine focuses on treating the patient as a whole, rather than focusing on just one part of the body.

Like an M.D., an osteopathic doctor attends four years of medical school and can practice in any specialty. But an osteopath also spends an additional 300 to 500 hours in the study of the body's musculoskeletal system and hands-on manipulative medicine.

Manipulation is a hands-on treatment that is done to make sure the body is moving freely. The motion is done to ensure the body's healing systems aren't being hindered in any way. It's based on the theory that the body's systems are interconnected.

Osteopathy dates back to 1874, when Dr. Andrew Taylor Still, an M.D., became frustrated with the medical practice. He believed the human body possessed the ability to heal itself. So he developed the manipulative techniques.

Common Shoulder Dysfunctions

Posterior shoulder musculature (rotator cuff). Anterior shoulder musculature. Notice the intimate relationship between the scapula and the rib cage. If the ribs and spine suffer from neuromuscular dysfunction, there is no way that the shoulder joint can’t be affected.

Shoulder problems are interesting and one of my favorite regions of the body to treat. One of the things that many health care providers fail to realize is the underlying cause of the degenerative processes that lead to eventual tissue failure. There is no reason that computer use would cause any more detrimental force than any other activity, on the contrary I would say just the opposite. Now if this is the primary activity of the involved shoulder then we have other considerations, such as progressive weakening, adaptive shortening of contractile tissues and an increase in fibrosis changes at the cellular level. All of these things can happen from disuse and misuse, or as a result of neuromuscular dysfunction. I find that the majority of people who suffer from a torn rotator cuff, tendonitis or other chronic irritations of this incredible joint have the latter, neuromuscular dysfunction (NMD). So what is NMD? It is a reflexive disorder of the body's built in soft tissue and joint injury defense system. In the shoulder is it most often present as upper thoracic spine dysfunction and associated costal cage dysfunction (ribs). This may sound strange, especially if you are like most people and tend to think of problems and the pain one feels as the same thing. In reality, the pain is usually not the problem, only a symptom of the dysfunction. The ribs, especially the top 5 are crucial to the functional integrity of the scapulothoracic joint (articulation of the scapulae and posterior costal cage). In most cases of shoulder NMD the contour of the ribs is uneven. A single rib or two that become elevated (posterior aspect of rib) and/or depressed (anterior aspect) can result in structural compensation of the entire shoulder girdle. The shoulder girdle is comprised of all of the 4 joints in the shoulder and all of the scapular and glenohumeral (true shoulder joint of upper arm and shoulder blade) musculature. When this happens there is a marked increase in the demands (load) placed on the muscles of the rotator cuff, especially the supraspinatus muscle. The rib dysfunction essentially causes a migration of the shoulder blade towards the front of the body and tilts the shoulder blade up and forward. This causes a marked increase in the stretch applied to the shoulder muscles in the back and a marked shortening of the shoulder muscles in the front. This looks like your typical poor, slouched posture, but has nothing to do with ones conscious ability to affect posture; it has everything to do with the bodies' reflexive protective spasm response to inappropriate nerve signals from our muscle and connective tissues. In some cases, the spine will not be bent forward; it will actually be in an extreme upright position. This is equally troublesome because it interferes with the mechanics of the scapulae and ribs by causing the same type of disturbance in the costo-vertebral joints (place where the rib attaches to the spine) found in the forward bent spine.

Strain and Counterstrain

Strain and Counterstrain was developed by Lawrence Jones, D.O. It has been used for over fifty years to improve range of motion and flexibility in athletes and other patients. Over the last 30 years, Strain and Counterstrain has been proven successful on all patient populations, including orthopedic, neurologic, geriatric, and pediatric. Strain and Counterstrain Technique eliminates protective muscle spasm in skeletal muscles. It is common knowledge that a skeletal muscle like the biceps muscle can go into protective muscle spasm. What is less widely known is protective muscle spasm of smooth muscle. Smooth muscle lines all the vessels in our body. When smooth muscle goes into spasm, it causes the vessels in our body to become rigid and inflexible. This affects blood pressure and overall circulation. In turn, this affects range of motion and joint mobility of neighboring joints because the body tries to protect the compromised vessel.

How it works – The basics of physiology

Muscle origin and insertion

All muscles have a starting point on a bone (origin) and an ending point on a bone (insertion). Muscles are attached to the bone by a tendon. Think of a chicken drumstick. When you pull the meat away from the bone, it is adhered at the end by a clear or whitish tough cord. This is the tendon. A therapist can move a muscle into a lengthened position (stretch) or shortened position by knowing the origin and insertion of that particular muscle. By moving the bones, muscles can be put into a fully lengthened position, a shortened position or anywhere in between.

Sensory Input and Motor Output

All muscles communicate to the spinal cord and brain (central nervous system) via sensory nerves and receptors located in the tendon. These receptors called golgi tendon organs and muscle spindle fibers, relay information about the length of the muscles and how fast and in what direction the muscle is moving the bones and joints. They also communicate what state of contraction the muscle is in at rest (muscle tone). This is a part of our sensory feedback system which the nervous system uses to decide how to instruct the muscle what to do next (motor output). Our sensory system is highly sophisticated and sensitive. It provides our nervous system with the information to make rapid decisions to plot a course of action based on the desired activity of the brain while also avoiding injury.

Muscle Tone

Our central nervous system supplies a certain amount of constant output to each of our muscles. This is called the muscles’ tone. Without any input the muscle is flaccid (abnormal state) as seen in a stroke. With too much output a muscle is spastic and can make lengthening movement of a muscle nearly impossible. In between flaccid and spastic is a resting state for normal that varies with the individual.

Muscle tone continuum

l_______l______l_______l_________l______l________l________l

FLACCID RELAXED NORMAL TENSE SPASM SPASTIC
(ABNORMAL) (ABNORMAL)

Muscle spasm – A vicious cycle.

A protective mechanism of the body based on these principles is called a muscle spasm. When the body perceives danger to a joint, the nervous system instructs the muscle to contract strongly to prevent movement that may cause damage. The muscle can stay in this state for a few minutes or a few days. It can become chronic and then this mechanism rarely serves to help or protect the body any longer and can become detrimental.

A vicious cycle is developed with pain, muscle guarding and muscle spasm.

A muscle in spasm is constantly sending signals to the nervous system, much like listening to music that is too loud. The nervous system reacts by sending strong signals right back. This is how a muscle can get into a vicious circle with the nervous system.

How it works – the technique

• The therapist identifies the muscle in spasm.
• The muscle can be in visible or palpable spasm or can be identified by “tender points”. The therapist positions the body so the muscle is in a shortened position and holds the position for at least 90 seconds. At times, the position is held greater that 5 minutes waiting for changes in muscle and fascia (tissues surrounding muscles and organs. More about this will be explained in future articles.)
• The therapist monitors tissue change and waits for optimum improvement to occur.

The shortened position of a muscle is a non-threatening position for a muscle in spasm. The communication from the muscle to the nervous system at this time is one of relaxation. The nervous system no longer receives the excessive feedback from the muscle and instructs the muscle tone to change from spasm to a resting tone. Relief and restoration of motion is often immediate. By disarming muscle spasm in major muscle groups the body is able to return to pain free function and pain free movement can be restored and built upon with exercise.

This technique lays the groundwork for rehabilitation of any painful condition. This technique is best used for:

• Spasm in any area of the body
• Post surgery in any area of the body
• Restoring more upright posture (tightened muscles can pull you into poor posture)
• Chronic pain

Can a muscle be in spasm (hypertonic) without a person knowing it?

Yes! People experience decreased mobility, tightness, or nothing at all if another muscle is compensating for it.

British College of Osteopathic Medicine Teaching Philosophy

Holistic Osteopathy at BCOM

Historically the College has, for many years, promoted the idea that optimal health depends not just on the impact of physical stresses but also the impact of biochemical, environmental and psychological stresses on the individual. Naturopathic osteopathy is a complex interaction which recognises the significance of each of these areas for the individual and attempts to restore a 'healthy balance' by the appropriate treatment and/or advice. These ideas were, at one time, considered to be somewhat radical but, particularly in the last decade, good quality research has confirmed their validity. Following on from these pioneering ideas a whole new area has now opened up in within medical research : the field of bio-psycho-social interaction on health.

Osteopathic Medicine

The therapeutic principles of osteopathic medicine are based on the understanding that the human body functions as a unit and has an inherent ability to self-regulate and self-heal. Holistic, or Naturopathic Osteopathy, as taught and practiced within BCOM's teaching clinics, is based on the Bio-Medico-Psycho-Social model of health care.

The treatment/therapeutic aims are to:

1. identify abnormalites/dysfunctions within the human structure and function.
2. facilitate the body's inherent abilty to self-heal by addressing the physical, bio-chemical, mental and environmental factors that may be either causing, pre-disposing or maintaining the state of disease.
3. empower the patient with knowledge and skills that can be used to not only promote wellbeing but also to prevent recurrence. Osteopathic medicine is therefore not prescriptive but preventative medicine.

Like any other form of healthcare, osteopathic medicine has it's own strengths and weaknesses, and therefore Osteopathic practitioners work closely with other health and medical practitioners in order to provide complete healthcare to patients.

Naturopathy is the particular philosophy which informs our osteopathic approach. The Naturopathic approach retains the fundamental elements of original Hippocratic doctrine.

Naturopathic Osteopaths hold that, in ideal circumstances, the individual has the capacity to adapt to and compensate for a great many (but not all) challenges to health. Under non-ideal circumstances certain adverse factors may result in the patient experiencing symptoms and/or signs of ill health. These adverse factors fall into three main categories: physical stressors, biochemical stressors, psychosocial stressors.

Definition of Osteopathic Medicine

Osteopathic Medicine is a system of manipulation, using the hands to correct joint and tissue abnormalities. Restoring physical and mental well-being, it makes it easier for a patient's body to function normally and use its own recuperative powers more effectively. Naturopathic, or holistic osteopathy focuses on more than diagnosing and treating the structural and mechanical problems of the body. It encompasses looking at diet, lifestyle and mental well-being to restore the state of balance within the total bodily function.

DOs and MDs Guide to Billing for OMT: OSTEOPATHIC MANIPULATIVE MANAGEMENT

We thank http://www.wvsominc.org/guideline.html

Also see:

WVSOM Tops Worldwide Rural Physician Rankings

GUIDELINES FOR CODING OSTEOPATHIC MANIPULATIVE MANAGEMENT


The following is the description of the new OMT codes as published in the 1994 edition of CPT. There are more than 500 new and revised codes in CPT 1994. The CPT Editorial Panel voted to accept the proposal of the AOA to move the osteopathic manipulative treatment codes from the HCPCS alpha-numeric system into CPT. With the advent of these new codes 98925-98929, one should no longer report claims using the M codes or 97260, 97261.

CPT - Codes Procedure Description


98925 - OMT; one to two body regions involved

98926 - OMT; three to four body regions involved

98927 - OMT; five to six body regions involved

98928 - OMT; seven to eight body regions involved

98929 - OMT; nine to ten body regions involved



These codes replace the MC700 series once found in HCFA's Common Procedure Coding System (HCPCS).

Note: For Medicare, the -25 modifier must be attached to the E/M code reported in conjunction with OMT. The entire coding system for evaluation and management (E/M) was changed. The new E/M codes range from 99201 to 99499 and are organized according to site of service, new vs. established patient and the level of care provided. The appropriate code to report is based on key components: history; examination; medical decision making; counseling, coordination of care; nature of presenting problem; and time. The first three components (history, examination and medical decision making) are considered the key components in selecting a level of E/M service.


Appropriate Use of OMT Codes

After the physician evaluates the patient and arrives at a diagnosis, it is allowable to use an evaluation and management (ElM) code in addition to the appropriate OMT code (98925-98929) provided the physician has documented in the patient's record the E/M service provided using the SOAP format. SOAP is an acronym for: Subjective complaints and histories from the patient; Objective findings of the physician's examination and any diagnostic tests performed; Assessment or differential diagnosis based on the first two items; and Plan, which is the recommended course of treatment developed by the physician.

Osteopathic Manipulative Treatment

Osteopathic manipulative treatment is a form of manual treatment applied by a physician to eliminate or alleviate somatic dysfunction and related disorders. This treatment may be accomplished by a variety of techniques. Body regions are defined as head, cervical, thoracic, lumbar, sacrum, lower extremity, upper extremity, pelvis, ribs, abdomen and viscera. (Such regions are defined in ICD-9 codes 739.0-739.9.) This information should be shown on the claim form or in the physician record.


Osteopathic Structural Diagnosis Includes: Somatic Dysfunction (By Region)

739.0 Head Region: Occipitocervical Region

739.1 Cervical Region: Cervicothoracic Region

739.2 Thoracic Region: Thoracolumbar Region

739.3 Lumbar Region: Lumbosacral Region

739.4 Sacral Region: Sacrococcygeal Region, Sacroiliac Region

739.5 Pelvic Region: Hip Region, Pubic Region

739.6 Lower Extremities: Acromioclavicular Region, Sternoclavicular Region

739.7 Upper Extremitiee

739.8 Rib Cage: Costochondral Region, Sternochondral Region, Costovertebral Region

739.9 Abdomen and Other

OMT Overview

However, it was only statistically significantly higher at 25 weeks postvaccination. In a cohort of patients with carpal tunnel syndrome, OMT was associated with both symptomatic and electrodiagnostic improvement.50, 75

In a blinded, randomized, controlled trial (n = 14) comparing standard medical care with standard care plus OMT for hospitalized patients with pancreatitis, patients in the OMT group had significantly fewer days in the hospital (mean reduction, 3.5 days, P = .04).76

There were no significant differences in time to oral feeding or amount of pain medications between the groups. Based on the exclusion criteria, the reader can infer that the 2 groups were roughly equal in terms of disease severity; however, the authors did not specifically state that the treatment and control groups were comparable based on Ranson criteria, Acute Physiology and Chronic Health Evaluation scoring, or some other objective measure of disease severity.

Osteopathic manipulative therapy has been used as adjunctive therapy in the treatment of pneumonia since the early 1900s. The only large-scale study evaluating the efficacy of OMT against pneumonia was a case series that was collected during the 1918 influenza epidemic in the United States consisting of 6258 patients with influenza complicated by pneumonia.

The average mortality rate for patients treated in the usual fashion with the prevailing therapy was approximately 25%. The mortality rate for patients who were treated with OMT in addition to the usual prevailing therapy was allegedly 10%.77 The only randomized control trial of OMT in this same setting also revealed a favorable trend.

In this trial, the mean duration of leukocytosis, intravenous antibiotic treatment, and hospital stay were shorter in the patients treated with OMT compared with the control group who received either a sham treatment or no additional physical contact.

However, none of these differences were statistically significant, possibly owing to insufficient power from the small sample size. The only outcome measure that did reach significance was total time taking oral antibiotics while in the hospital.77

Osteopathic manipulative therapy provided acute benefits in a small group of patients with idiopathic Parkinson disease (IDP).78 Ten patients with IDP and 8 age-matched controls without IDP having similar physical conditions, underwent computerized gait analysis before and after a single session of OMT.

A separate group of 10 patients with IDP underwent a sham manipulative treatment. The patients did not know when the measurements for gait analysis were being taken, and were not aware of whether the treatment they were given was the sham treatment or OMT. Before motion analysis, all patients with IDP underwent a 12-hour medication washout period.

All patients with IDP had mild to moderate disease with a Unified Parkinson's Disease Rating Scale Motor Score average of 14.3; however, the study lacks a comparison table, so how well the groups were matched cannot be fully determined. Patients with IDP who were treated with OMT had statistically significant increases in stride length, cadence, arm swing, and maximum velocities of upper and lower extremities, compared with the control group without IDP.

Significant differences occurred only in patients with IDP who were treated with OMT and not in IDP patients who received a sham treatment, suggesting that the improvements were the result of OMT. The duration of this beneficial effect is unknown because patients were not followed up further.

The single report of OMT as an isolated treatment for episodic tension-type headache found a reduction in pain intensity immediately after the treatment, but the subjects were also not evaluated further.79

A controlled trial of chiropractic spinal manipulation did not show a positive effect on episodic tension-type headaches.80 Another similar trial did, however, find a beneficial effect of manipulation on cervicogenic headache.81

CONCLUSIONS

Osteopathic medicine is similar to allopathic medicine, but places a greater emphasis on the importance of the musculoskeletal system and normal body mechanics as central to good health. To support this emphasis, more basic research and controlled trials for the effectiveness of manipulation are needed.

GLOSSARY

Autonomic Innervation of Selected Viscera

Sympathetic fibers supplying the heart and lung and part of the esophagus originate in the first 5 thoracic segments.

Those supplying the pancreas, liver, stomach, and gallbladder arise in the 5th through 10th thoracic segments, and those supplying the small and large intestine and kidneys arise in the eighth thoracic to second lumbar segments.

Facilitation

Facilitation is the maintenance of a pool of premotor neurons or preganglionic sympathetic neurons in 1 or more segments of the spinal cord in a state of partial or subthreashold excitation; in this state less afferent stimulation is required to trigger the discharge of impulses.

It is also a neurophysiological theory regarding the neural mechanism of somatic dysfunction.

Somatic Dysfunction

Somatic dysfunction is the impaired or altered function of the skeletal, arthrodial, and myofascial structures and their related vascular, lymphatic, and neural elements.

The positional aspects of somatic dysfunction are described using 1 or more of 3 parameters: (1) the position of the body part as determined by palpation and referenced to its adjacent defined structures, (2) the direction in which motion is freer, and (3) the direction in which motion is restricted.

Somatic dysfunction is characterized by one or more of the following: vasodilatation, edema, tenderness, pain, constriction, asymmetry of motion, motion restriction, and changes in tissue texture. It may or may not be associated with organic disease.

Author/Article Information

From the Internal Medicine Service, US Army Medical Activity, Heidelberg, Germany.

Corresponding author: Emil Lesho, DO, CMR 442 Box 594, APO AE 09041-0501. Accepted for publication November 13, 1998.

Archives of Family Medicine,Vol. 8 No. 6, November/December 1999

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