Monday, February 27, 2006

TMJ or Jaw Problems

The tempro-mandibular joint is located on each temporal bone just forward of the external auditory meatus or ear canal. Since the lower jaw is attached to the temporal bones via this joint it isn't any wonder that a displacement or mal position of these two temporal bones could cause joint pains to occur over a period of time.
The temporal bones have the capability to move and rotate like off centered wheels, (back and out, or forward and in), depending on the side affected. This displacement creates an environment for the TMJ joint to become irritated by the misalignment of these bones.
NCR has the ability to reposition these bones without surgery or medications. It is recommended that this procedure be coordinated with the patients' dentist as to maximize the positive affects of this treatment. Allergies: In the 1950's and 1960's Osteopathic doctors used a form of NCR for treating breathing and sinus problems. In anatomical terms NCR increases the diameter of the nasal passages which are made up of cranial/facial bones.
When moved/opened, these bones allow for more air to pass through the nasal passages, thus decreasing the congestion by increasing the volume of nasal air. More air equals dryer passages equal fewer bacteria with less tissue reactions to ingested air particles.

JAW PAIN and Osteopathic Manipulative Treatment

FAMILY MEDICINE® COLUMN
By Martha A. Simpson, D.O., M.B.A.
Assistant Professor of Family Medicine
Ohio University College of Osteopathic Medicine

READER’S JAW PAIN CAN PROBABLY BE TREATED WITHOUT SURGERY

Question: A few weeks ago I began having pain in my left ear. I thought it was an ear infection, and I went to the doctor. He said I had a TMJ disorder. Could you tell me what causes this and what I can do to get better? My doctor is sending me to an oral surgeon. Will I need surgery?

Answer: Temporomandibular joint (TMJ) syndrome is a painful condition that causes inflammation in the joint created by the temporal bone in the skull and the lower jaw bone (or mandible). As you can see, the term “temporomandibular” comes from combining “temporal” and “mandible” to make an adjective. Therefore, the abbreviation "TMJ" literally refers to the joint itself, although it is often used to refer to the disorder rather than the joint.

There are many things that can cause this problem. Teeth that don’t align properly -- “malocclusion” in medical lingo -- is a very common cause. Some people grind their teeth -- a condition called bruxism. This usually occurs at night and can lead to pain in the TMJ. Injury to the jaw or the side of the head can also cause TMJ syndrome. And, you can get arthritis in the TMJ, just like any other joint in the body.

The primary symptom is pain with opening and closing the mouth. This pain is usually worse in the morning and is just in front of the ear. This pain can radiate to the ear, cheek, neck or shoulder. Some people also complain that their jaw catches when they open their mouth. Some people have a grating or clicking sound in their TMJ when they eat.

Your doctor probably made the diagnosis of TMJ syndrome by feeling this joint with his fingers while you opened and closed your mouth. This is a technique we call palpation. He may have felt clicking or deviation of the jaw to one side when you opened your mouth. Also, he may have noted that you couldn’t open your mouth as wide as normal. You may have indicated that you felt pain when he applied slight pressure as he palpated the joint. And, depending on the results of this physical examination, he may have asked for an X-ray or MRI to aid in the diagnosis of your condition.

In most cases, TMJ syndrome can be treated with dietary modifications to eliminate very chewy foods, gum chewing and ice eating. Non-steroidal antiinflammatory drugs (NSAIDs) like ibuprofen are also very helpful as is moist heat to the area a couple of times a day for 10-15 minutes. Some people who grind their teeth or have pronounced malocclusion benefit from a dental appliance that prevents the jaw from closing completely. This has been shown to relieve the symptoms in over 70 percent of patients with TMJ problems. Some cases of TMJ syndrome respond very well to osteopathic manipulative treatment; so, if your physician is a D.O., you might ask if this manual medicine technique might be effective in your case. Fortunately, the odds are you probably won’t need surgery. Statistically, the need for this is rare; it is indicated in less than 5 percent of cases.

Family Medicine® is a weekly column. To submit questions, write to Martha A. Simpson, D.O., M.B.A., Ohio University College of Osteopathic Medicine, P.O. Box 110, Athens, Ohio 45701. Medical information in this column is provided as an educational service only. It does not replace the judgment of your personal physician, who should be relied on to diagnosis and recommend treatment for any medical conditions. Past columns are available online at www.familymedicinenews.org.

Sunday, February 26, 2006

Olympics Gold Medalist uses an osteopathic doctor for sports injury treatments

Apolo injury flares up at Games

11:02 AM PST on Wednesday, February 22, 2006
By MIMI JUNG and ALLEN SCHAUFFLER / KING 5 News



Apolo Anton Ohno is being treated for a flare-up of a leg injury he sustained last fall, according to his father, Yuki Ohno.


According to Yuki Ohno, Apolo had been feeling fine until his first day on the practice ice in Torino. Yuki Ohno told Mimi Jung of KING 5 News that getting Apolo healthy has been his primary focus and that his son's recovery this past week has been "phenomenal." He calls it a "miracle" that Apolo's been feeling much better.

When Jung spoke with Apolo Ohno after his 1,000 meter final, Ohno told her he had a lot of pain in his legs and Yuki Ohno attributes some of that to the ankle and hamstring injury. Yuki Ohno has a blog on NBCOlympics.com and in it he wrote in part:

"He needed to overcome his injury, stemming from the ankle, connecting his pelvis to his hamstring firing pattern that he was troubled with since Day 1 at ice training session in Torino. His osteopathic doctor, Dr. Lavine from Tacoma, Wash., has been with him all week to heal his injuries.

"It's just so demanding, he needs to heal extremely quickly in order to be back on the level he should be. But it's been moving positively and his status has been upgraded every 24 hours. Day-to-day the difference in his healing is taking an amazing turn!"

U.S. Speedskating is now acknowledging there is some kind of physical problem, but they're downplaying it, saying they don't want to give out a lot of information and give opponents an edge.

Ohno skates today (Wednesday) in the 500 meters and will race in the 5,000 meter relay.

Dozens of teens turn out for health conference, learn about Osteopathic Manipulative Treatment

Source:By LACHLAN MACLEAN/Times Herald correspondent
Vallejo Times Herald

Touro University medical students reached out Wednesday to help dozens of local teens on a host of health issues from drug use to eating disorders.
In their first Teen Life Conference, 150 students from Touro's schools of osteopathic medicine, pharmacy and health sciences used lectures and one-on-one discussions to highlight more than 15 prominent health issues. Among the issues were allergies and teen pregnancy.

The conference also offered a number of health screenings, including blood pressure checks, skin and eye examinations and body mass index evaluations.

About 70 students from Vallejo's Jesse Bethel, Hogan and Vallejo high schools and Mare Island Technical Academy milled around the booths and lecture hall, hands full of informational pamphlets and handouts.

Aaron Aquino, 17, a Jesse Bethel High School senior, said the conference was very informative.

"They taught us important stuff about staying healthy, especially about STDs and drugs," Aquino said. "More students should come next time, because they don't focus too much on these subjects in high school."

Event organizers Samantha Pecson and Melody Padilla had been working on the conference idea since last summer.

"I think it was a good turnout for our first event," Pecson said. "We're very excited, students are coming and getting involved, and you can really feel the volunteers' enthusiasm. We hope they will come again next year and bring even more people."

John Glover, chairman of Touro's school of osteopathic manipulative medicine, said that in addition helping the teens, the medical students were able to get valuable experience diagnosing and discussing maladies.

"The (Touro students) are getting experience treating real people with real problems, and getting a chance to apply what they've learned in class," Glover said. "It's a good contrast to the lectures and lab work."

Richard Hassel, Touro's vice president of administration, said the event was "awesome," and he was "thoroughly impressed" with the event's organization.

"Part of our curriculum is community involvement, and it is important that Vallejoans take advantage of the benefits of having a medical school in their community," Hassel said. "I'm so proud of these future doctors; they did this on their own initiative."

David Swedler, 25, a student doctor of osteopathic medicine, said it was "very rewarding" to participate in the first Teen Life Conference, and hopes the event will grow in the future.

"It was great to be able to pull together as a school and do something good for the education and wellness of the Vallejo community," Swedler said. "I think everyone involved got something valuable out of this experience."

DO vs. MD and MD vs.DO?

Source: http://www.stronghealth.com/services/primarycare/domd.cfm


If you are like most people, you probably don't know the difference between a medical doctor, MD, and an osteopathic doctor, DO.

DOs and MDs are alike in many ways:

Applicants to both DO and MD colleges typically have a four-year undergraduate degree with an emphasis on science courses.


Both DOs and MDs complete four years of basic medical education.


After medical school, both DOs and MDs can choose to practice in a specialty area of medicine—such as psychiatry, surgery, obstetrics, or sports medicine—after completing a residency program (typically two to six years of additional training).


Both DOs and MDs must pass comparable state licensing examinations.


DOs and MDs both practice in fully accredited and licensed hospitals and medical centers.


Both are medical doctors; MD is specifically Doctor of Medicine and DO is Doctor of Osteopathic Medicine.

What Makes DOs Different?
DOs can perform surgery, child delivery, treat patients, and prescribe medications in hospitals and clinic settings.


DOs look at the "total person." Osteopathic physicians focus on preventive care. Instead of just treating specific symptoms or illnesses, they look at the whole body.


DOs receive extra training in the musculoskeletal system, which is comprised of the nerves, muscles, and bones. This training gives DOs a better understanding of how an injury or illness in one part of the body can affect another part of the body; therefore, DOs have a therapeutic and diagnostic advantage.


DOs use what is called osteopathic manipulative treatment (OMT). OMT is a technique in which the DOs use their hands to diagnose injury and illness, giving special attention to the joints, bones, muscles, and nerves. Manipulations improve circulation, which in turn, creates a normal nerve and blood supply, enabling the body to heal itself.

Saturday, February 25, 2006

The Osteopathic Approach to Seizures

by Viola Frymann, D.O., F.A.A.O., F.C.A.
http://www.osteopathiccenter.org/seizures.html

Seizures may occur at any stage in life from newborn to old age. But the etiology or underlying cause may vary from patient to patient. Rare causes are organic brain diseases.

For the child who develops seizures such conditions may be ruled out by elector-encephalogram, (EEG) computerized tomography (C.T.) scan or magnetic resonance imaging (M.R.I.).

Another causative factor may be trauma, a head injury following a car accident, bicycle accident, football or other high speed sports mishaps, a fall from a tree, or even an upper bunk especially if there is a door knob or hard table obstructing the fall and causing a focal blow to the head.

Such injuries will be identified in the course of history-taking and confirmed in many instances by X-ray (C.T. or M.R.I.). A far more common traumatic factor, and far less easily identified injury may have occurred during the process of birth.

The nine months of pregnancy is arranged anatomically and physiologically to provide the utmost protection to the developing baby within the mother's abdomen.

The process of labor whereby the baby is delivered into this world is also designed to bring the baby into this world without injury.

However modern "civilization" with high heeled shoes, refined, processed flavored, colored foods, chemical solutions in place of wholesome healthy drinks of spring water, exposure to toxic chemicals in the workplace as well as the stresses on the job may all bring detrimental influences to the developing baby within mother's body.

The period of pregnancy may be a healthy, happy, joyous experience until the expected date of delivery draws near. Labor begins, or at least the contractions seem like labor. Contractions continue, somewhat erratically for a few hours or days only to reveal themselves as false labor. The baby in the womb has been compressed by the uterine contractions on his buttocks and sacrum (the large bone at the base of the spine), and his head may have been compressed as it was pushed into the pelvis before the birth canal opened to permit an easy passage.

On the other hand there may have been no false labor, and the real labor begins according to expectation. Then mother experiences severe back pain, which suggests that the baby has turned face forward instead of face backward.

Progress is retarded because this position makes passage through the birth canal more difficult. This is but one of the possible traumatic events that can occur during the birth process and affect the delicate musculoskeletal mechanism of the baby.

Perhaps you can see that your baby has a crooked or asymmetrical head, perhaps your baby throws his head back forcibly and screams. This is like a cramp in the neck, and it hurts! But these are indications that the delicate nervous system within the skull and spine has suffered some degree of trauma.

There are many degrees and varieties of trauma that may occur during the birth process. Ten percent of babies may suffer visible, obvious trauma. Ten percent of babies may be perfect with free physiological motion and function throughout. But about 80% of new born babies may have less visible, but nevertheless significant strain factors within their body mechanism.

Some of these produce microscopic injuries to areas of the brain which may manifest exteriorly as jerking of muscles, spasms in parts of the body with or without changes in consciousness, and even full seizures affecting the whole body.

Other children may vomit after many feeds or they may have been slow to learn to suck effectively, they may cry inconsolably, their muscle tone may be markedly increased, and tense or limp or flaccid. There are other signs that may appear later in childhood that indicate that microscopic injury may have occurred during the birth process, but in areas of the brain that do not come into full function at the time of birth.

The osteopathic physician is trained to identify these subtle changes in the musculoskeletal system and apply gentle manipulative skills to correct them.

In many instances the neurological problems can be profoundly benefited by such treatment. The earlier in life the treatment can be given the better the results.

The magnitude of the brain injury is also a factor in the degree of response. When a child is diagnosed as having a seizure disorder various diagnostic tests will be performed and in many instances anticonvulsant medication will be prescribed. Progress under osteopathic treatment will be measured by reduction in intensity and frequency of seizures and in positive changes in the EEG.

However the objective of treatment regardless of the intensity or severity or the problem is to enable this child to function at the maximum of his/her potential.

Friday, February 24, 2006

Using Osteopathic Manipulative Treatment (OMT) to Treat Torticollis

Source: Pin-Chieh Chiang

A few weeks ago, a special visitor came to my school: a 5-month-old infant with torticollis. Torticollis is a condition where the muscles of the neck are contracted, producing slanting and twisting of the head to one side. The baby smiled and sat on his mommy's lap while 40-plus medical students sat in a half circle around him. Even when my professor, Dr. Cislo, approached him, he didn't shy away.


Dr. Cislo did not touch the baby right away. Instead, she worked on making eye contact. She let the baby play with her scarf and fingers, while she slowly made physical contact starting at the extremities. All the while, she was getting the history and physical from the parents and giving us students a demonstration of the proper way to approach a baby.


For those of you who aren't familiar with OMT (osteopathic manipulative treatment), it involves using the hands to diagnose, treat, and prevent illness or injury. Dr. Cislo proceeded to treat the baby with OMT. "Babies," she said -- "you have to treat them wherever they are, can't just position them and expect them to stay still." She showed this by working around the baby and mother, changing positions and adapting to the baby as he was breastfeeding, getting burped, or just fussing around.




The baby cried during the treatments, and it was hard not to cringe for him. But Dr. Cislo is a professional and she would show the mom how little force she was using through each technique so as not to worry her. Just as Dr. Cislo was explaining, "You know the treatment works when the baby calms down, because his pain is released," the baby actually stopped crying. From that point on, he was much more compliant.




After the treatment, my classmates and I watched for the baby's reaction. He was being his smiling, bouncing self. Like any other infant, he was happily playing with his toes. It didn't seem remarkable… until the mother said, "That's the first time he's played with his feet." A few days later, the mother contacted Dr. Cislo to remark on how her baby has turned over for the first time and how he can tolerate his physical therapy sessions much longer now. The mother also mentioned the indirect effects such as the baby being more playful, staying awake longer, eating better, and using his left arm more.




That day, it was very inspiring to see my professor in her physician mode. I know that a lot of my professors are more than just the lecturer I normally get to interact with. It makes me look forward to rotations, to when I will get more chances like these to learn first-hand from my professors. It was also very awesome to be able to see OMT work outside of the classroom. Often in the laboratory setting, I rarely succeed in treating my partners with OMT. This is because most of the time my partners don't have any serious problems and also because I am still learning how to execute the techniques properly. Still, I definitely love all the concepts of OMT; otherwise I wouldn't be at an osteopathic school.




This isn't intended to be a comprehensive clinical study about the effects of OMT. But on that day, this mother and her beaming baby had nothing but thanks for Dr. Cislo's wonderful work.

Osteopathic Medicine plus Osteopathic Manipulative Treatment (OMT)

Source:Missouri Association of Osteopathic Physicians & Surgeons
http://www.maops.org/

Osteopathic Medicine plus Osteopathic Manipulative Treatment (OMT) resembles the old country song, "I was country when country wasn't cool."

Osteopathic medicine's philosophy was based on holistic medicine by its founder A. T. Still in 1892, long before managed care and hospital systems began to market the holistic approach to health care. And, the osteopathic philosophy has withstood the test of time and scientific scrutiny; it is more widely accepted now than any time in its over 108 years of existence.

In a time when medical advances, state-of-the-art surgeries, miracle drugs and alternative medicine steal the pages of most every publication, osteopathic manipulation is an effective part of medical care provided by osteopathic physicians. Not alternative medicine - but traditional medical care with an added dimension of health care, provided to osteopathic physicians' patients.

OMT: Hands-On Care

Osteopathic physicians (D.O.'s) provide you with all the best that medicine has to offer. Their knowledge and use of the latest medical technology, complemented by a hands-on diagnosis and treatment tool known as Osteopathic Manipulative Treatment, or OMT.

D.O.'s use OMT to diagnose, treat, and even prevent illness or injury.

Osteopathic Medicine: A Unique Philosophy of Care

The Big Picture

Osteopathic physicians (D.O.'s) take a whole person approach to care. They look for underlying causes for a disease; they consider your physical condition, plus mental and emotional factors.

The Musculoskeletal System

D.O.'s believe that all of the body's systems, including the musculoskeletal system, work together, and that disturbances in one system may impact function elsewhere in the body.

D.O.'s place particular emphasis on the musculoskeletal system, which comprises two-thirds of the body's mass; they use OMT to manually assess and treat illness or injury.

OMT and How It Can Work for You

OMT is predicated upon your osteopathic physician's (D.O.'s) knowledge of medicine. While manipulative medicine is commonly associated with physical ailments such as low back pain, this far-reaching treatment modality can also be used to relieve the discomfort or musculoskeletal abnormality associated with a number of disorders.

The osteopathic approach to treating many diseases includes medication and/or surgical intervention, plus manipulation. OMT can relieve muscle pain and can hasten your recovery from illness/injury by promoting blood flow through tissues.

Your Structural Exam

Diagnosis

Through extensive osteopathic training in manipulative medicine, osteopathic physicians (D.O.'s) can detect changes in tissue, however small, that signal injury or impairment.

Treatment

Using a variety of OMT techniques, your D.O. will apply manual forces to your body's affected areas to treat structural abnormalities, and will then apply specific corrective forces to relieve joint restrictions and misalignments.

Who Can Benefit From OMT

Through OMT, people of all ages and backgrounds have found relief from pain and dysfunction.

Osteopathic Medical Education

Osteopathic physicians (D.O.'s) complete four years of medical training at one of the accredited colleges of osteopathic medicine. The osteopathic curriculum is intensive and broad-based. It includes comprehensive training in the musculoskeletal system and use of OMT.

Upon graduation from osteopathic medical school, D.O.'s complete a one-year internship, rotating through all areas of primary care. Then, they complete a residency in one of the more than 120 specialty and subspecialty areas of medicine.

D.O.'s and M.D.'s are the only recognized, educated and trained physicians to provide comprehensive medical care and have unlimited practice rights in all fifty states.

For further information on the differences, refer to our web site brochure, "What is a D.O., What is an M.D."

Tuesday, February 21, 2006

WHAT IS A DO( Doctors of Osteopathic Medicine)?

Doctors of Osteopathic Medicine (DOs) are the legal and professional equivalents of Doctors of Medicine (MDs). They are licensed to practice medicine in all 50 states and use all conventionally accepted therapeutic modalities such as surgery, radiology, and drugs. They are eligible to enroll in all federal programs, managed care and insurance plans, serve as commissioned medical officers in all branches of armed services, and serve as public health officers, coroners, insurance examiners, and team physicians. In other words, they practice complete medicine and surgery. Only DOs and MDs can do this.

DOs represent about 5% of the country's physicians and provide care for approximately 10% of the patients. This is because higher proportions of osteopathic medical graduates enter into primary care residencies after graduation compared to their MD counterparts.

Andrew Taylor Still, MD founded osteopathic medicine in the late 1800's in response to what he thought was poor medical practice at that time. He based osteopathic medicine on the following principles:

1) The structure of the body and its functions work together, inter-dependently.

2) The body systems have built-in repair processes which are self-regulating and self-healing in the face of disease.

3) The circulatory system provides the integrating functions for the rest of the body.

4) The musculoskeletal system contributes more to a person's health than only providing framework and support.

5) While disease may be manifested in specific parts of the body; other parts may contribute to a restoration or a correction of the disease.

The preparation and training of DOs is nearly identical to the training of MDs. Admission prerequisites and curricula are very similar. DOs can sit for the MD boards if they are interested in pursuing a MD residency after graduation.

The primary difference in their education is that DO students complete an additional 200-300 hours of training in osteopathic manipulative medicine (OMM). OMM is a modality used primarily to treat musculoskeletal problems and overlaps in its scope with physical therapy and manual medicine techniques. Also, DO schools place more emphasis on producing primary care physicians than do some MD schools. This means that during their clinical years, students at DO schools spend more time rotating through primary care specialties such as family medicine, pediatrics, obstetrics and gynecology, internal medicine, and psychiatry. Nevertheless, specialty training isn't out of the question for DOs. Many DOs seek and obtain residencies in surgical and non-surgical specialties.

Monday, February 20, 2006

What does "somatic dysfunction" mean?

[The following article was published in the San Diego Workers' Compensation Forum Newsletter. Osteopathic physicians frequently use the term "somatic dysfunction" to describe certain musculoskeletal diagnoses. This article was designed to explain this term to insurance adjusters and other Workers' Comp professionals.]
Patient A: 25 year-old male electrician presents with a stiff, sore neck of one day’s duration. Denies trauma. Spent previous day looking upward, pulling wires through ceiling. Started bothering him as he went to bed. Woke up not able to turn his neck.
Diagnosis: Neck sprain/strain (Somatic dysfunction: cervicothoracic junction)

Patient B: 20 year-old female visiting nurse slipped while descending staircase at a clients home. Managed to catch herself with the railing as she fell backwards, hence she did not actually strike the ground. No pain at the time, but within an hour or so, begins to feel sharp pain in the middle of the back associated with painful deep inspirations.

Diagnosis: Thoracic sprain/strain (Somatic dysfunctions: thoracolumbar junction and ribs)

Patient C: 35 year-old male construction worker bent forward to pick up a jackhammer that had been lying in a hole. Thought he felt a "tweak"/popping sensation as he stood up, but didn’t hurt. Next day, he begins experiencing aching in right side of his low back and finds he has some restricted movement in the region. No changes in his genitourinary or gastrointestinal systems, nor does he complain of radicular symptoms.

Diagnosis: Low back sprain/strain (Somatic dysfunction: lumbosacral region)

You know what a sprain/strain means – the patient did not sustain any bony injuries such as a fracture, i.e. a "soft-tissue" injury. But what about these "somatic dysfunction" diagnoses – is this doc trying to pad his bill?

No, in fact a Doctor of Osteopathic Medicine (D.O.) uses this term in an attempt to be more specific regarding their diagnoses. A sprain refers to a stretch-type injury of a ligament, whereas a strain refers to muscles and tendons. In the above mentioned examples, neither one of these mechanisms is responsible for the patients’ complaints. Rather, a mechanical restriction occurs first, which is usually followed by a reflex increase in muscle tone/spasm.

Allopathic physicians refer to this as "facet syndromes;" Chiropractors refer to them as subluxations. To osteopathic physicians, somatic dysfunction refers to impaired or altered function of related components of the somatic (body framework) system: skeletal, arthrodial, and myofascial structures, and related vascular, lymphatic and neural elements.

Recall the fact that humans are machines containing an internal skeletal supporting structure. The vertebral column contains 3 regional curves (cervical, thoracic, and lumbar), that can be easily visualized from the side. These curves are important because they help to cushion the discs and spinal cord from excessive or unexpected forces.

Sidebending a spine in its neutral posture (i.e. with curves intact) is generally well-tolerated and without ill-effects as the individual vertebral segments accommodate to the movement, as a group, and return back to their neutral postures once the movement is completed.

On the other hand, let’s say that there is a loss of normal curvature in a region when sidebending is attempted. The spinal mechanics are different. Rather than behaving as a group, a single vertebral segment must "give in" to allow for the segments above and below it to sidebend. [Try this simple experiment: fold an 8" x 11" piece of paper in half (so that it becomes 4" x 11"). Grasp the folded edge using the thumbs of both hands and attempt to bend the "spine" of the paper. You’ll observe that the paper must "kink" in order to promote bending.]

Incidentally, this "kink" doesn’t have to cause pain right away. In fact, the reflex mechanisms that kick in may not induce discomforts until 1-3 days later. Why the inspiratory rib discomforts seen with thoracic problems? This is because the rib heads articulate with the thoracic vertebral segments. If a particular segment is restricted in its motion, the adjacent rib will be affected, as well. Hence, a rib that is prevented from its normal inspiratory excursion causes pain (that often originates from the back and radiates anteriorly around the chest).

Finally, why bother using the term at all – isn’t sprain/strain still good enough for coding purposes? The reason has to do with a procedure called Osteopathic Manipulative Therapy (OMT). If a D.O. performs OMT as part of his/her overall treatment plan, a diagnosis of the appropriate regional somatic dysfunction needs to be included in order to support the need for this particular treatment modality (e.g. one wouldn’t code a laceration repair without a diagnosis of a laceration!).

Therefore, in summary, D.O.’s may list both the allopathic and osteopathic diagnoses as part of their assessments. The former to provide a sense of what is going on with the patient using conventional terminology, the latter to address billing documentation concerns.

So, what's the difference between Osteopathic and Chiropractic medicine?

Over the subsequent years, Still and the growing D.O. community integrated the Osteopathic principles and practices into their practice of medicine. That is, they would still use drugs or perform surgery if needed, but their general maxims were "Above all, do no harm." and "Keep it pure." In other words, D.O.'s were not defined by manipulation, rather, they were defined by their philosophy and manipulation/palpation happened to be a "really good tool" that was used. (In all honesty, D.O.'s didn't all agree that they wanted to do this; they were spurred on to do this by changes that were going on within the allopathic community, the Flexner Report on medical schools, etc.) D.C.'s, on the other hand, limited their practices strictly to manipulation, and did not teach "materia medicae" (essentially, medical therapeutics) in their schools at the time.

OK, back to the 1990's: Is there any difference between manipulation between a D.O. and a D.C.? Probably not. There are many different ways to mobilize joints and which technique is selected is more likely based upon the skill and comfort of the practitioner, not to mention the size/shape of the patient. I have chiropractic friends (who recently entered D.O. school incidentally) who would adjust me when I would need it using techniques very similar to mine.

How much manipulation training do D.O.'s receive? I can't quote the exact number of hours but they were a lot. In addition to our regular traditional medical school classes (anatomy, biochemistry, pharmacology, etc.), we would have at least one hour of Osteopathic Principles and Practices each day, for each semester that we were in classes. So generally, we spent longer times in school each day, in comparison to our M.D. colleagues.

What about holistic medicine? Do M.D.'s practice holistic medicine? As I noted, the concepts of structure and function being inter-related, etc. have all been pretty much accepted by the medical community nowadays, but whether or not most M.D.'s actually think about this is another matter. Philosophically, Osteopathy can be considered more closely aligned historically with Chinese medicine, which took a holistic approach. Allopaths (M.D.'s) philosophy stems way back to ancient Egypt where they used to have individual gods for different things. Body parts were sort of compartmentalized - there may have been a god to care for extremities, another for chest, etc.. This type of thinking does not lend itself as well to a holistic approach. The result today: the majority of D.O.'s practice primary care medicine and the majority of M.D.'s specialize.

Osteopathic Medicine Profession Overview

Source:http://www.oucom.ohiou.edu/OsteoMed.htm

With 100 million patient visits to osteopathic physicians in the United States each year, it is clear that osteopathic medicine is gaining ever wider acceptance by the general public. Men and women holding the doctor of osteopathy, or D.O., degree can practice in a full range of medical specialties anywhere in the country. Most D.O.s, though, are in family medicine and the other primary care disciplines of general pediatrics, general internal medicine and general obstetrics and gynecology. To understand why this is so, it may help to understand a little about the profession's roots.

The osteopathic profession was begun in the late 19th century by Andrew Taylor Still; a man of strong passions, he was both a supporter of women's rights and an outspoken abolitionist. When the Civil War broke out, Still, not surprisingly, entered the Union Army to enlist in the fight to crush slavery and worked as a regimental surgeon. After a series of medical tragedies in his own family, Still dedicated himself to the study of the physical and mechanical structure of the human body.

In 1874 Still laid the cornerstone of osteopathic medicine by describing the principles and philosophy on which the profession was to be based. This philosophy viewed the human body as a single organism in which each part interacts with and influences every other part. D.O.s, therefore, are taught to treat each patient as a whole person, rather than focusing just on the area that is causing the immediate medical problem.

Osteopathic physicians are also specially trained to use a procedure called osteopathic manipulative medicine. This technique makes it possible for physicians, when appropriate, to use their hands to help diagnose illness and treat patients. By manually examining the patient, osteopathic doctors can detect subtle changes in the body's structure, with special emphasis on the joints, bones, muscles and nerves. By using direct or indirect pressure to move the muscles and bones, doctors often improve circulation and nerve response, helping the body heal itself.

What Still began was, in essence, a reform movement directed against the widespread abuses and inefficiencies of the health care of his time. Since then, osteopathic principles and manipulative techniques have become recognized as valid medical concepts which are as exciting now as they were a hundred years ago. This is because the osteopathic approach leads to a profoundly personal, "people-oriented" style of practice that today's medical students find very rewarding. During his or her medical education, the D.O. student learns to treat the person as well as the disease and is taught that the physician's role is to facilitate the body's own natural recovery mechanisms. It's not surprising that with this focus the majority of D.O.s become family doctors who provide the "grass roots" type of general health care so much in demand in the United States today.

Osteopathy and Osteopathic Manipulative Treatment Today

Osteopathy - Developed 130 years ago by physician A.T. Still, osteopathic medicine is one of the fastest growing healthcare professions in the U.S. and brings a unique philosophy to traditional medicine. With a strong emphasis on the inter-relationship of the body's nerves, muscles, bones and organs, doctors of osteopathic medicine, or D.O.s, apply the philosophy of treating the whole person to the prevention, diagnosis and treatment of illness, disease and injury.

Osteopathic manipulative treatment, or OMT, is hands-on care. It involves using the hands to diagnose, treat, and prevent illness or injury. Using OMT, your osteopathic physician (D.O.) will move your muscles and joints using techniques including stretching, gentle pressure and resistance.

Osteopathic Manipulative Medicine ( OMM )
What is it?


Started in 1874 by Dr. Andrew Still in the United States , Osteopathic medicine specializes in the spinal and joint health. Osteopathic therapy works with the natural healing abilities of the body and considers the whole person. Osteopathic physicians commonly treat the cause of the problem rather than focus only on symptom relief. The osteopathic approach is an emphasis on the person’s health instead of disease.

Osteopaths study the relationship between the structures and functions of the body. The approach considers the inseparable connection of the body’s functioning to the emotional and spiritual aspects of the person as well. At the core of Osteopathic Medicine is belief in the body’s innate ability to self- heal. The osteopath’s role is to find structural alterations and by manipulation, improve the structure and therefore the function. By restoring these, the whole body will maintain better overall health. Thorough knowledge of all systems of the body and training in the comprehensive osteopathic approach is the main difference between this and other forms of manipulative bodywork or therapy.

What can I expect?

The Osteopath will palpate and choose from a variety of techniques such as manipulation, casts, medication, or in severe situations, even surgery. Plans are made with you individually that will consider many aspects of your life. Most commonly, manipulation is part of every treatment plan. Manipulation is gentle and therapeutic. It may involve releasing restriction or dysfunction wit myofascial release, muscle energy (contracting your muscles), thrust techniques that cause “popping” sensations, or strain- counter strain (going into the position of strain).

What are the reported benefits?

The benefits list is as long as the types of dysfunction that can present in the body. Many people think that the benefits are isolated to back pain and injuries. However, Osteopaths specialize in treating the healthful functioning of the whole body.

How much does it cost?

Osteopaths practice in a huge variety of settings and environments so the cost will be influenced accordingly. They are licensed to practice the same scope of medicine as medical doctors so expect costs to be in a similar range.

What kind of training does my osteopath have?

Registered Osteopaths have a degree or diploma in Osteopathy. Osteopaths attend four-year osteopathic medical schools. In addition to traditional medical school, osteopaths receive 300-500 hours of structural diagnosis and hands-on treatment. Osteopaths are qualified to perform surgery and prescribe drugs. Many Osteopathic schools offer masters in public health, research, or education, or PhD’s, in combination with the Doctor of Osteopathy.

Myofascial Pain Syndrome (MPS) and Osteopathic Manipulative Treatment

Myofascial Pain Syndrome (MPS) is a is a painful musculoskeletal condition, a common cause of musculoskeletal pain. MPS is characterized by the development of Myofascial trigger points (TrPs) that are locally tender when active, and refer pain through specific patterns to other areas of the body. A trigger point or sensitive, painful area in the muscle or the junction of the muscle and fascia (hence, myofascial pain) develops due to any number of causes. Trigger points are usually associated with a taut band, a ropey thickening of the muscle tissue. Typically a trigger point, when pressed upon, will cause the pain to be felt elsewhere. This is what is considered "referred pain".

These factors can cause trigger points:

•Sudden trauma to musculoskeletal tissues (muscles, ligaments, tendons, bursae)
•Injury to intervertebral discs
•Generalize fatigue (fibromyalgia is a perpetuating factor of MPS, perhaps chronic fatigue syndrome may produce trigger points as well)
•Repetative motions; Excessive exercise; Muscle strain due to over activity
•Systemic conditions (eg, gall bladder inflammation, heart attack, appendicitis, stomach irritation)
•Lack of activity (eg, a broken arm in a sling)
•Nutritional deficiencies
•Hormonal changes (eg, trigger point development during PMS or menopause)
•Nervous tension or stress
•Chilling of areas of the body (eg, sitting under an air conditioning duct; sleeping in front of an air conditioner)

The fascia is a tough connective tissue which spreads throughout the body in a three dimensional web from head to foot without interruption. The fascia surrounds every muscle, bone, nerve, blood vessel and organ of the body, all the way down to the cellular level. Therefore, malfunction of the fascial system due to trauma, posture, or inflammation can create a binding down of the fascia, resulting in abnormal pressure on nerves, muscles, bones or organs.

This can create pain or malfunction throughout the body, sometimes with bizarre side effects and seemingly unrelated symptoms. It is thought that an extremely high percentage of people suffering with pain and/or lack of motion may be having myofascial problems; but most go undiagnosed, as the importance of fascia is just now being recognized.

Many of the standard tests, such as x-rays, myelograms, CAT scans, eletromyography, etc., do not show the fascia. (John Barnes, P.T., 1992)

Occassionally, trigger points produce autonomic nervous system changes such as flushing of the skin, hypersensitivity of areas of the skin, sweating in areas, or even "goose bumps." The trigger points cause localized pain, although TrPs can involve the whole body.

In three studies, the prevalence of myofascial TrPs among patients complaining of pain anywhere in the body ranged from 30% to 93%; (among patients with chronic craniofacial pain, 55%; and for lumbogluteal pain, 21%.)

The characteristic electrical activity of myofascial TrPs most likely originates at dysfunctional endplates of extrafusal muscle fibers. This dysfunction appears to play a key role in the pathophysiology of TrPs. (Simons 1996)

Subjective shortness of breath can be part of the myofascial pain syndrome of the levator scapulae muscle. In one study, 75 patients who reported neck pain & shortness of breath were examined. Trigger points were located and inactivated with acupuncture needles (dry needling). 68 of the 75 patients in the study reported that their shortness of breath and soreness were abolished immediately after inactivation of the TrPs. The other 7 patients needed a second trial of inactivation. Eliminating the trigger points eliminated the symptoms. (Journal of Muskuloskeletal Pain, 1996)

Like fibromyalgia, Myofascial Pain syndrome is an often misunderstood condition. Even today, some doctors either don't believe that MPS exists or they don't understand its symptoms and treatment.


Treatment of MPS can only begin after an accurate diagnosis is accomplished. Methods for managing this painful condition:

• Trigger Point Therapy {Myofascial release therapy, myotherapy, massotherapy (medical massage therapy)}
• Spray and Stretch technique (stretching of the muscles involved with a vapocoolant spray - a coolant is sprayed on the trigger point to lessen the pain and then the muscle is stretched. this is often done by a physical therapist.)
• Trigger Point Injections (local anesthetic,such as lidocaine, injected directly into the trigger points)
• Dry Needling (the use of a needle without injecting anything)
[TrP injections and dry needling mechanically disrupt the tirgger point. The use of lidocaine is no more effective, but it reduces the soreness afer injection. For MPS there is no role for injected steroids]
Osteopathic manipulation treatment
• Craniosacral Therapy
• Physical Therapy (hands-on)
• Exercise
• Improvement of nutrition
• Changing sleeping habits
• The use of tricyclic antidepressants in low doses
• Elimination of stress; Biofeedback; Counseling for depression that may result from this painful condition

An active trigger point when treated well or with rest will become latent (quiet, or not causing active symptoms). It can often resurface after trauma after acute overload or fatigue, or even sudden exposure to cold. Conversely, new trigger points may arise elsewhere, or at least become more sinificant as others become latent.

For MPS, you should see a doctor knowledgeable in chronic pain such as a physical medicine doctor (a physiatrist), or a neurologist. The diagnosis is made by the history and physical exam. There is no lab test nor imaging studies to confirm the diagnosis. A history of acute trauma or chronic overuse should be looked for.. On exam, there is typically restricted motion with pain of the affected muscle. Other medical problems need to be ruled out with imaging or other studies. For instance, if a patient presents with back pain, disc and other problems need to be ruled out.

Altered Pain Perception Accompanies MPS: A Danish study indicates that people with chronic myofascial pain perceive and transmit pain differently than people without the syndrome. As many as 72 percent of people with fibromyalgia may have trigger points associated with myofascial pain.
Source: "Qualitatively altered nociception in chronic myofascial pain," by L. Bendtsen, R. Jensen, and J. Olesen, Pain, 65 (1996), pages 259-264

Osteopathic Philosophy

http://osteopathicphilosophy.com/op_society.htm

Good Book:



Osteopathic Medicine:
Philosophy, Principles and Practice.



Published by Blackwell Science,
March 2001.

“At this late date many seem to forget that a basic discovery of Dr. Still was the fact of immunity…. The whole living structure (not just the backbone) which embraces function, or vice versa, is something more than just a sum of the parts; and the sum of the parts is not confined to one class of tissue, e.g. bones…. The practical everyday problem resolves itself into what the individual measure of the particular case is. It is not a composite collective one, but composite and unified, with multiplicity in unity. ”
JAOA , March 1935.

Sunday, February 19, 2006

AT Still Quotes

"NO GREATER TITLE CAN FOLLOW A NAME"




“A student of life must take in each part of the body and study its uses and relations to other parts and systems”


“...fascia and its nerves demand his attention first, and on his knowledge of the same, much of his success, and the life of his patients do depend.”

“No two or more organs can work perfectly when one is crowding on another.”


AT Still DO,MD.

Friday, February 17, 2006

Muscle Energy Technique

Source: http://www.osteopatia-still.com/english/impagina_tecnica.asp?id=38&tecniche=Muscle%20Energy%20Technique

Founder: Mitchell Fred L. Sr., D.O., F.A.A.O.

Principles: A series of articular tests evidences articular hypo- and hyper-mobility due to muscular spasms and hypertonicity. Recourse to isotonic contractions against resistance modifies the muscle’s state of contraction and frees the articulation.

Method: According to the ascertained articular problem, there is a specific position of correction where the patient is asked to effect three isotonic contractions against resistance supplied by the osteopath.

Indications:
all types of acute and chronic articular hypomobility and hypermobility. This method is also indicated for children and is an excellent alternative to the generally more invasive classic manipulations.

Osteopathic Medicine Philosophy

Source: (c) 2000, 2001 June Leslie Wieder


In 1874, Andrew Taylor, M.D., became dissatisfied with the existing medical fields and the use of dangerous drugs and compounds for "curing" illnesses. Taylor believed that the body has an inherent ability to heal itself if its systems were in balance.

Taylor felt that a doctor could promote self-healing by minimizing obstructions to blood and lymph flow, and keeping the musculoskeletal system in alignment. He developed techniques to manipulate soft tissue and bone. His work was instrumental in laying the groundwork for osteopathy medicine.

Dr. William Sutherland enrolled in a unorthodox medical school in the late 1890s. Later, as an osteopath, he was intrumental in advancing and changing the concepts of "self-healing."

Dr. Sutherland's theory that the central nervous system was in "constant rhythmic motion" was later validated by advanced diagnostic equipment. This constant rhythmic motion was found to be essential for life and well being. He believed that a dysfunction in one area of the body would lead to a compromise of the entire structure of the body.

In "Five Components of the Primary Respiratory Mechanism," Dr. Sutherland summarized the working principles of osteopathy:

1. There is motion at the cranial sutures, the joints linking the 26 bones of the skull

2. There is expansion and contraction of the hemispheres of the brain

3. There is motion of the membranes covering the brain and spinal cord

4. There is a fluid wave within the cerebrospinal fluid that baths the brain and spinal cord

5. There is involuntary, subtle motion of the sacrum.

These principles are the basis of the treatment protocols of osteopathic medicine.

Osteopathic medicine is similar to traditional, or allopathic, medicine but it places a much greater emphasis on the role of normal body mechanics and the musculoskeletal system. One of the principles of osteopathic medicine is that the patient's illness and traumas are stored within the structure of their bodies

The osteopath is trained to palpate (touch) the body to detect tissue texture, flow of fluids, and motion of joints, and to seek out impairments caused by traumatic injuries and chronic or acute illnesses. The objective of the osteopathic physician is to restore the body to its normal or full function by applying a precise amount of force to promote movement of fluids, (a rhythmic flow of cerebrospinal fluid in the brain and spinal cord), decompress joints and bones , and increase tissue function.

The body is a unit where dysfunction in one areas can affect another area. For example, a disc problem in the neck can pull the legs and affect the way we walk. Treatment for the legs can significantly reduce the neck pain.

Osteopaths treat birth and pediatric problems such as palsy, colic, and learning disorders. They also treat neck and back problems such a headaches, sciatica, overuse syndrome and trauma.

Among the systemic problems successfully treated by osteopaths are, nerve problems, digestive disorders, infections,such as sinitus and colds, chronic ear infection, respiratory promblems such as asthma and allergies.

Ortho-Bionomy

Ortho-Bionomy is a gentle non-invasive approach.that is osteopathically based. The practitioner uses gentle movements and positions of the body to facilitate change and reduce stress patterns. Arthur Lincoln Pauls, the creator, choose to work with the line of lease resistance. Ortho-bionomy means "a correct application of the natural laws of life."

During a session, tension points and restricted movements are located. Slight compression is applied while gentle rocking and holding an area until a release has occurred.

Ortho-Bionomy has been found to be effective for chronic pain, injuries, and structural imbalances.

Craniosacral Therapy

Dr. John E. Upledger who is an osteopathic physician and surgeon, developed therapies that he calls Craniosacral Therapy and Somato-Emotional Release. These therapies are based on the theories of William Sutherland. D.O.

Dr. Upledger's success is largely due to his extensive clinical research and his committment to look beyond conventional approaches. .He is considered one of the leading authorities in whole-body therapies.

Craniosacral is non-invasive, gentle approach. This technique was developed by an osteopath to balance the flow of the cerebralspinal fluid that circulates in a loop from the skull to the sacrum. This craniosacral system uses the menigeal system (the membranes of the brain and spinal cord) which constantly bathes the spinal cord and brain. The CSF is continuosly pumped in a rhythmic fashion with contraction and expansion.

Restrictions to the flow can result in a number of neuromuscular disorders and create chronic pain.

The practitioner first seeks to locate restrictions in the cerebrospinal fluid flow, which most often occurs in the skull and pelvis. Treatment consists of gentle pressure on bones and soft tissue from the head to the base of the spine to improve circulation of the cerebrospinal fluid. Sessions last up to one hour.

Most effective for treating head traumas, headaches, sinus congestion, TMJ, behavorial problems and neurological impairments. Used on infants who suffer from respratory and digestive disorders (colic) congenital, and genetic problems.

Myofascial Release

Source: http://www.drwieder.com/osteopathic.htm

Myofacial release is an osteopathic term coined by Dr. Robert Ward John, Barnes, a physical therapist developed a system that evaluates the fascia by using osteopathic methods, craniosacral therapy, Structural Integration, and physical therapy.

Myofascial release is a gentle approach that identifies and releases constricted areas in the connective tissue surrounding nerves, muscles, and bones. The belief is that the connective tissue becomes constricted due to illness, stress, or injury.

Treatment consists of strokes and stretching called unwinding, which helps the practitioner find specific areas of trauma called still points. Sessions can be from 30 to 90 minutes. Myofascial therapists also teach the patient

stretching exercises to help them maintain their health.

Myofascial release relieves pain associated with muscle tightness, headaches, fibromyalgia, and scoliosis, and can help recovery from injury.

Myofascial therapy provides relief for chronic neck and back pain, and aids in the recovery of spinal cord injuries. It also is effective for traumatic stress syndrome and some disorders of the nervous system.

OSTEOPATHY AND POSTURE

Source: http://www.posturepage.com/osteopathy/index.html

Osteopathic treatment concentrates on the relationship between the structure of the body - the skeleton, muscles, ligaments and connective tissue - and the way in which the body moves and functions. The literal meaning of the word osteopathy is 'bone disease' - a rather unfortunate term that does nothing to evoke the great benefits of this safe, natural system of diagnosis and treatment. To an osteopath, the body functions as a complete, working system, so any problems affecting its structure, upset the balance of our general health. For this reason, an osteopath will not simply want to ease the pain and stiffness in your neck, but also want to know what is causing that pain, which could be anything from physical injury to mental anxiety.

The therapy was devised in the 19th century by an American doctor, Andrew Taylor Still. He became disillusioned with medicine when three of his children died of viral meningitis. Still sought an alternative in the philosophy of Hippocrates, who claimed that the 'cure of disease lies within the body'. An interest in osteopathy developed through his belief that tension in muscles and misaligned bones places unnecessary strain on the body. This strain can be caused by any number of things, such as physical injury, bad posture, or by emotions such as anger and fear.

Whatever the cause, Still believed it could be eased by adjusting the framework of the body, so that all the systems within it would run smoothly and the body could heal itself. Of all the bone structures in the body, Still considered the vertebrae of the spine to be the most important. Still's reasoning was simple: the spine protects the spinal cord, a major part of the nervous system, and the nervous system penetrates every area of the body, controlling voluntary and involuntary movement and registering every sensation, from the most delicate smell, to tortuous pain. Still believed that anything interfering with the nervous system could resonate in every area of the body.

Osteopathy is not just about bones - easing muscular tension also plays a considerable part. This belief that a relaxed muscle will feel comfortable, is based on the physiological fact that muscles use up energy when they contract, wastes energy and makes muscles less elastic, and therefore more prone to becoming damaged. Tense muscles slow down the circulation and lymphatic systems, so that your body's growth and elimination processes are restricted. They inhibit heart function and can worsen the effects of common respiratory conditions, such as asthma.

Osteopathy is a hands-on therapy. Through touch, massage, manipulation and stretching techniques, an osteopath can diagnose and treat people with physical and emotional problems. Since osteopaths are concerned with the structural integrity of the whole person, there are no formally recognized specialities. However, some practitioners develop their expertise in specific fields, such as the treatment of children, elderly, sports injuries or pregnancy-related problems. Similarly, some osteopaths choose to concentrate on certain methods, such as cranial technique, which focuses on the patient's breathing and the nervous system, concentrating on diagnosing and correcting imbalances through gentle manipulation of the skull.

Other practitioners specialize in visceral techniques, in which the internal organs are manipulated by massaging the abdomen or working on the nerve centers along the spine. This form of osteopathy can improve the position of an organ, break down adhesions, ease congested tissue and improve muscle function. Osteopaths often liken their therapy to a three-legged stool; one leg represents the chemistry of the body, which relies on a healthy diet for strength; the second represents the physical structure of the body; and the third symbolizes emotion, mental and spiritual health. The seat is the influence of the heredity over the whole person. Just as the stool can't balance if one leg is broken, a person can't be healthy if one aspect of their health is affected. This is why an osteopath will treat every aspect when relieving a disease which appears to affect only one.

Muscular and joint pain, backache, sciatica, headaches, sports injuries, arthritis and rheumatism can all benefit from osteopathy. It can ease the discomfort of pregnancy and PMS and the gentle touch of pediatric and cranial osteopathy can benefit children, from easing colic to calming hyperactivity.

Wednesday, February 15, 2006

Website Pick of the Month!

Great Website!

http://www.drreiss.com/

Many Thanks to Wesley Beth Reiss, D.O. for an excellent website full of nice articles.

CRANIAL OSTEOPATHY

Source: http://www.drreiss.com/

Cranial Osteopathy is a prominent sub-specialty of Traditional Osteopathic medicine, and was discovered, developed and taught by William Garner Sutherland, DO, starting with his own research in the early 1900s and continuing ceaselessly until his passing in 1954. He determined that there is a palpable movement within the body that occurs in conjunction with the motion of the bones of the head. This is a rhythmic alternating expansion and contraction motion in the cranium, independent of the rhythms of heart beat or breathing, which is part of the Primary Respiratory Mechanism (PRM). This motion exists in every cell of the body and can be felt and worked with in any part of the body by a trained physician. The aim is to free up restrictions in the PRM and allow the subtle natural rhythms of the central nervous system to express themselves in a balanced fashion.

Cranial Osteopathy is uniquely suited to treat problems related to the skull and brain, yet it can potentially affect any situation arising from disease or trauma in the body. Even an almost imperceptible alteration of the skull's natural configuration and movement in infants can lead to such disorders as colic, the inability of the baby to swallow, or frequent spitting up or delayed development. Trauma affecting this mechanism can lead in adults to low back problems, headaches, breathing and digestive disorders, joint pains, menstrual disorders and repetitive stress injuries such as tendinitis.


--------------------------------------------------------------------------------

With the heightened awareness of cranial manipulation, it is vital to understand the distinctions between "Cranial Osteopathy" (also known as Osteopathy in the Cranial Field) and "craniosacral therapy." Only DOs, MDs, DDSs or DMDs have the comprehensive education to fully diagnose and treat patients - and to practice Cranial Osteopathy. In fact, Dr. Sutherland always emphasized that the cranial concept was only an extension of, not separate from, Dr. Still's science of Osteopathy.

Physicians with training in Cranial Osteopathy recognize that the PRM impacts every cell of the body, interfaces and guides the physiology of the entire body and is not restricted to the cranium, spinal cord, dura and sacrum. Osteopathic physicians do not separate the body into a somatic portion and a cranial portion but instead treat the body as a whole. When working on any one part, the physician is in contact with all parts. Therefore medical and scientific knowledge is essential when treating with Cranial Osteopathy and in-depth knowledge is acquired only with a comprehensive medical education.

Some of Dr. Sutherland's techniques have been isolated and simplified by John Upledger, DO in the 1970s to create what he calls "Craniosacral therapy." Claiming full credit for these techniques, Dr. Upledger states, "The requirements to do craniosacral therapy were dedication, compassion and sensitivity... not organic chemistry, neurology, materia medica or other science courses." The Upledger Institute is open to all licensed health care practitioners, though the majority of practitioners trained in "craniosacral therapy" are massage therapists, chiropractors, and physical and occupational therapists.

A final word on Cranial Osteopathy from it's discoverer, Dr. Sutherland...

"Have you ever had a thought strike you?

I have told many times of the thought that struck me before I graduated from the American School of Osteopathy. [In trying] to prove that motion between cranial bones in the living adult is impossible ... I gained knowledge not only of the articular mobility of the skull but also of the Tide and something within that I call the 'Breath of Life.' I do not consider this contribution of thought mine - I call it a guided thought.

The goal with your patients is to find the way to healthy function within the mechanism that they bring to you. Study the Life principle and come closer to understanding what I mean by the 'Breath of Life.' To the digger who will take time to dream and the dreamer who will wake up and dig, the science of osteopathy will unfold into a magnitude equal to that of the heavens."

Edgar Cayce and Osteopathic Medicine

Source: http://www.drreiss.com/

Since age 21, Edgar Cayce (1877-1945) demonstrated the uncanny ability to put himself into a kind of self-induced sleep state by lying down on a couch, closing his eyes, and folding his hands over his stomach. This state of relaxation and meditation enabled him to place his mind in contact with what many believe to be all of time and space. From this state he could respond to questions as diverse as, "What are the secrets of the universe?" to "How can I remove a wart?" His responses to these questions came to be called "readings" and contain insights so intriguing and detailed that even to this day individuals have found practical help for everything from maintaining a well-balanced diet and improving human relationships to overcoming life-threatening illnesses and experiencing a closer walk with God.

Six decades ago this farmer from Kentucky, who became one of the most versatile and credible psychics ever known, was already emphasizing the importance of diet, attitudes, emotions, exercise, and the patient's role - physically, mentally, and spiritually - in the treatment of illness. As a result, he has been sometimes been called "the father of holistic medicine" and has been recognized for foreseeing the direction of health care.

Edgar Cayce was a strong proponent of Traditional Osteopathy above all other forms of medicine and manual therapy. Out of 14,000 total readings during his lifetime, he specifically recommended Osteopathy over 6,000 times, such as in this quote...

"There is no form of physical mechano-therapy so near in accord with nature's measures as correctly given osteopathic adjustments. Others may say what they may, but prove it by watching those who have them regularly, and who depend on them." (reading 1158-31)


For additional information on Edgar Cayce and the foundation that continues the research into his compelling work, please follow the link provided below.
Since age 21, Edgar Cayce (1877-1945) demonstrated the uncanny ability to put himself into a kind of self-induced sleep state by lying down on a couch, closing his eyes, and folding his hands over his stomach. This state of relaxation and meditation enabled him to place his mind in contact with what many believe to be all of time and space. From this state he could respond to questions as diverse as, "What are the secrets of the universe?" to "How can I remove a wart?" His responses to these questions came to be called "readings" and contain insights so intriguing and detailed that even to this day individuals have found practical help for everything from maintaining a well-balanced diet and improving human relationships to overcoming life-threatening illnesses and experiencing a closer walk with God.

Six decades ago this farmer from Kentucky, who became one of the most versatile and credible psychics ever known, was already emphasizing the importance of diet, attitudes, emotions, exercise, and the patient's role - physically, mentally, and spiritually - in the treatment of illness. As a result, he has been sometimes been called "the father of holistic medicine" and has been recognized for foreseeing the direction of health care.

Edgar Cayce was a strong proponent of Traditional Osteopathy above all other forms of medicine and manual therapy. Out of 14,000 total readings during his lifetime, he specifically recommended Osteopathy over 6,000 times, such as in this quote...

"There is no form of physical mechano-therapy so near in accord with nature's measures as correctly given osteopathic adjustments. Others may say what they may, but prove it by watching those who have them regularly, and who depend on them." (reading 1158-31)

AN OVERVIEW OF OSTEOPATHY

Source:http://www.drreiss.com/
by Wesley Beth Reiss, D.O., P.C.

If you get a deep cut in your finger, the attending doctor will disinfect, close, and bandage the wound. In a week the cut is mended. Did the doctor heal you? Actually, no. Your own body did. But the physician assisted - by setting the stage and removing obstacles that might interfere with your body's repair processes. In much the same way but with a larger scope, a physician who practices traditional Osteopathy (or Osteopathic Manipulative Medicine) removes the impediments to normal body functions and corrects the physical abnormalities that cause disease and inhibit recovery. This allows your own innate healing abilities to come forth and restore you naturally to optimal health.

Osteopathy is both a type of medical practice and a philosophy - interchangeable and inseparable. Practitioners have their knowledge solidly rooted in the nuance of anatomy, their guidance found in the unerring wisdom of the body, their partner in healing the elemental energies of life. Doctors of Osteopathy (D.O.s) are fully licensed physicians with credentials equal to M.D.s, who practice all phases of medicine, including writing prescriptions and performing surgery. However, they are trained to look at the whole person; mind, body, and spirit, rather than focus on diseased parts. They understand that the human body has a nearly unlimited power to heal and maintain itself, but sometimes needs assistance in removing obstacles that block it from achieving its full health potential.

D.O.s have learned how the body’s systems work together, and why a small physical disturbance in one area may greatly impact functions elsewhere. They are concerned with determining what is causing an imbalance in the body and why. Osteopaths have found that once the underlying causes have been diagnosed, treated, and removed, the body is then free to repair itself or to respond to other appropriate therapies more successfully.

History of Osteopathy

Traditional Osteopathy is an entirely American form of holistic medical care that was developed in the late 19th century by Andrew Taylor Still, MD. Dr. Still, a frontiersman and civil war physician, was dissatisfied with the crude and often toxic medicine of his day. By observing wildlife and the elegant relationship between structure and function, he originated a new system of medicine, which he called "Osteopathy." He noted that when adequately nourished and rested, the body can heal and maintain itself if all its parts are in their correct position and free to move within the normal range of motion. Dr. Still developed the first manipulating techniques in modern medicine, used to restore structure and function, and started treating his patients with this new concept in 1874. Owing to his ever-growing success and the demand that generated, he founded in his home town of Kirksville, Missouri the first Osteopathic college in 1892. 19 such colleges are now teaching Osteopathy nationwide.

The full benefits of Osteopathy were widely revealed during the Great Flu Epidemic of 1918. 500,000 deaths were seen in the United States from this disease, and those who were admitted to hospitals had an alarming fatality rate. However, patients treated by Osteopaths had only one sixteenth as high a fatality rate. Their mobilized immune system effectively fought the infection, while congestion in the lungs and other waste products from virus die-off were thoroughly drained.

One of Dr. Still's students, Dr. William Garner Sutherland, greatly expanded the science of Osteopathy by developing in the late 1930's the field of "Cranial Osteopathy." He found that the primary rhythm of the body, from which all other energy flowed, was revealed in the pulsing of cerebral and spinal fluids. This rhythmic pulse, not related to heartbeat, respiration, or any previously known cycles of the body, creates a coiling and uncoiling of the spinal cord that can be felt by a trained practitioner anywhere on the patient. Special osteopathic manipulation of the cranial bones and sacrum can then gently free up restrictions and balance this primary rhythm movement. The functioning of the central nervous system is improved, which then impacts the health of the entire body. His concepts and therapies were so unique, even to Osteopathy, that he worked for decades before they were finally accepted by his colleagues.

As Osteopaths struggled after WWII to gain equal recognition as MDs, their practices shifted as well in that direction towards conventional allopathic medicine. The manipulative techniques that made them special were all but lost. One of the few Osteopaths who steadfastly maintained the techniques and philosophy of traditional manipulation during this time was Dr. Robert Fulford, who helped bring back Dr. Still's and Sutherland's teachings to the newest generation of physicians. His own work included the development of the Fulford Percussor as well as a profound study of how Osteopathy affects and enhances the energy field of the body. Dr. Reiss had the privilege to train under Dr. Fulford, and more than any other physician, she models the principles of her practice after his work.

Today, Osteopaths comprise about 5% of all physicians in the U.S., but with their comprehensive training and personable orientation make up 15% of all rural doctors. Unfortunately only 1 out of every 10 Osteopaths nationwide actually use their traditional manipulative techniques as a primary modality. The remaining large majority, perhaps owing to the relative convenience, continue to put aside their holistic training and practice mostly conventional medicine identical to their allopathic MD counterparts. This ratio may be changing, as it has been reported that more medical students "see the writing on the wall" and are shifting their emphasis towards the ever-more-popular holistic approach of Traditional Osteopathy. Dr. Still's and Sutherland's work has also generated over the past century several "spin-off" therapies, including chiropractic and "craniosacral," which by their origin are limited to a small percentage of an Osteopathic physician’s training and full range of healing techniques.

How Osteopathy Works

Osteopathy has been defined as "a comprehensive system of diagnosis and treatment, based on the interrelationship of anatomy and physiology, for the study, prevention and treatment of disease." The entire body, if adequately nourished, functions to maintain, repair and heal itself to the best advantage if its structure and physiological functioning are in proper order.

Osteopathy emphasize the following four fundamental principles:

The human being is a dynamic unit of function.
The body possesses self-regulatory mechanisms which are self-healing in nature.
Structure and function are interrelated at all levels.
Rational treatment is based on these principles.

Doctors of Osteopathy understands that health will manifest to its fullest potential only when all parts of the body are in correct relationship to one another and free to move within their normal range of motion. They know that resistance to disease depends on normal blood and nerve supply. Such integrated totality emphasizes the fundamental need for the physician to consider the individual who has the diseases rather than the disease which has the individual - the principal approach being through proper normalization of the total body structure.

When putting these principles into action, they first find imbalances in the anatomy, often old and hidden, by touch. They then apply gentle manipulation to the bones, muscles, organs, and all connective tissue over the entire body to restore normal structure and remove restrictions. This enhances all circulatory systems, allowing the body’s own healing powers to better reach ailing areas. D.O.s also consider how all aspects of a patient’s life, including diet, exercise, physical and emotional stresses, genetic, and environmental and occupational issues, influence their overall state of health.

By combining natural therapies with a physician’s knowledge of western medicine, Traditional Osteopaths work to correct the true underlying cause of dysfunction. They can relieve pain, prevent disease, and speed recovery from nearly all medical problems. Often they can reduce or even eliminate the need for more intrusive therapies such as medication or surgery.

Osteopathy and Dentistry

Source: Dr. Farid Shodjaee
St. Laurent Dental Centre Ottawa, ON

Cranio-Dental Orthopedics

Dentists and Osteopaths are working together more and more nowadays. This makes great sense, because there is a fundamental relationship between proper, balanced movement in the face and mouth and in the rest of the body. In other words, there is a body attached to the head! The connection between the position of the teeth when the jaw is closed (OCCLUSION) and how osteopathy can influence this by working on the head and body as a whole is very complicated.

The Importance of Treatment

There are direct connections between the alignment of teeth, the symmetry of the joints, the curves of the spine, the levels of the shoulder blades and pelvis, and leg length.

You can see this for yourself if you wear an appropriate heel lift in your shoe for just a day; afterward there may be discomfort in the areas that are connected.

It is important for those who have malocclusion to have their whole bodies examined by an Osteopath. If the problems in the jaw are solved, then many other connected problems can also be helped. Among these are:

Backache
Breathing difficulties
Dteriorating eyesight
Headache
Hormonal problems
Painful teeth
Sinusitis
Scoliosis

Sometimes a common toothache may be due to a problem of restricted movement in the upper part of the neck. An over-stimulated nerve in this area irritates the nerve in the face.

Most people think that the skull and the face are made up of a bones that do not move. From the observation and work of skilled osteopaths, however, it is clear that the head is instead a dynamic and mobile structure. All the bones in the cranium are designed to move, or "breathe" slightly - the primary respiratory mechanism or PRM. The sutures joining the bones together are like movable hinges, allowing a gentle spreading; this gives a pumping action to the system, without which it will not work as it should.

OSTEOPATHY and DENTISTRY



Distortion of the Jaws (MALOCCLUSION)

In my practice I am concerned with the size, shape and relationship of your teeth so that they fit together properly. Underdeveloped or distortion of one or both jaws and therefore the teeth are well recognized in dentistry. Corrections must be done directly by developing the arches and straightening the teeth by various kind of braces.

We need our jaws to fit together well to have a healthy gums and teeth. The joints and the soft tissues that work the jaws also depend on this. If all is as it should be, we can talk, chew and grind without causing any problems.

he ligament that attaches the teeth to its socket is called the periodontal ligament. It is highly sensitive and richly supplied with nerve fibers. This is how we are aware of even the smallest variation of pressure on each tooth remember what it feels like to have a piece of celery string caught between your teeth! This sensitivity shows how important it is to have even contact between the teeth.

Signs of Malocclusion
There are a number of clear signs and symptoms that show problems in how a person’s jaw fits together. Among these are heavily worn teeth, shiny spots or grooves on fillings and teeth that are not straight in the jaw. The patient may also have had problems with broken teeth or fillings; clenching or grinding of teeth (especially at night); white lines in the mouth; and scalloped edges to the tongues.

Malocclusion can begin with a difficult birth, inherited problem of too many or too few teeth, a blow to the face or jaw or poor diet can also create difficulties. Even where it looks like a child may have inherited some problems, though, there are likely t be other factors that could benefit from osteopathic and dental treatment. Ideally, treatment should begin as soon as possible after the birth.

Birth Trauma and Malocclusion
It has been known for some time that many problems that dentists are called upon to deal with are developmental. and may in part be caused by difficulties during the birth of a baby. Osteopathic work with the primary respiratory mechanism has further recognized the significance of such trauma. The process of birth can sometimes compress the head, and such babies may have asymmetric faces and unusually high palates.

Some of the following symptoms in an infant or young child can suggest problems:

Allergies
Behavioral or learning difficulties
Recurrent ear infections
Eye problems
Hyperactivity
Nasal symptoms
Difficulties in swallowing
Snoring
Daytime tiredness
Habits such as breathing through the mouth, thumb-sucking, tongue-thrusting, biting the lips, sleeping only on one side of the face and early or late loss of baby teeth are signs of difficulties that must be treated as soon as possible. Osteopath and your dentist can work together to remedy the situation.

If the compression are treated early enough by an Osteopath the results may be twofold: immediate release of the restriction; and gradual remolding of the abnormalities in the structure of the jaws. The best insurance against future malcurvature of the spine and malocclusion is when the osteopath removes the restrictions in the newborn that prevent the normal movement of the primary respiratory mechanism (PRM) in the head.

Most people have not had the opportunity of this treatment by an Osteopath, and they develop malocclusion that now require some kind of orthopedics and/or orthodontic treatment preferably as a young child where there is still growth potential. Unfortunately if this malocclusion is not treated in children it will give rise to so many jaw and/or teeth problems in adulthood. Such as broken teeth, periodontal disease, severe worn dentition, jaw aches, headaches and many other related symptoms.

Other causes of Malocclusion

Direct trauma to the jaw and face can also cause problems. Falling forward on to the chin and blows to the jaw can distort the temporomandibular joints (TMJ) and compress the bones of the face and head. Having teeth out can also leave unwelcome forces between and inside the bones of the mouth and face, so if possible avoid having any teeth removed - unless it is absolutely necessary.

If some teeth are missing, or only one side of the mouth is used for chewing, an unequal and considerable strain is placed on one joint.

The cheek bones continue to grow throughout your life. So where a person’s teeth are all removed and dentures fitted, there may be bone loss in the face over a period of time. The dentures may therefore need to be built up to compensate for this. If the dentures are the wrong height, they may create an imbalance in the jaw muscles

Osteopathic Manipulative Treatment now witnessing a resurgence under western names in India.

Traditional techniques for joint and spinal manipulations are now witnessing a resurgence under western names in India.


Imagine this. You walk down the road. Overlook a banana peel, slip and fall. Result—a sprain. The next day a ball hits your child's knee while he is playing. Result—a broken leg and a brawl. The same day, your friend bends down to lift up his heavy suitcase. Result—a sudden and searing backache.

What do you do? You apply some ointment on your sprain, your kid wraps his knee in a plaster, and your friend, much to his chagrin, undergoes an operation. But why not opt for some traditional methods of treatment that could cure much better? Such as osteopathy and chiropractic?

Osteopathy is a technique that uses body massage and bone manipulation. Dorling's Pocket Medical Dictionary defines osteopathy as "a system of therapy based on the theory that the body is capable of making its own remedies against disease and other toxic conditions... (and) emphasizes the importance of normal body mechanics and manipulative methods of detecting and correcting faulty structure". Explains Dr Krishna Murari Modi, an osteopath based in Mumbai, India: "Apart from a clinical examination, osteopaths depend on palpatory diagnosis: the feel of the tissue, the feel of the muscle, the feel of movements at the intervertebral joint. X-rays cannot detect minor spinal changes. So, once the defect is detected, adjustments are done by positioning the patient in a specific manner and giving sharp, short jerks. The patient begins to feel immediate relief." Until recently, Dr Modi was the only osteopath in the country. "When I came to Mumbai in 1975 and started practicing, there was no one in the country who offered osteopathic treatment." Dissatisfied with the limitations of orthopedic treatments, he decided to learn osteopathy.

Osteopathy dates back to the early '20s. It was created by Dr Andrew Tailer Still, an Army surgeon who got disillusioned with conventional medicine when his three children died of spinal meningitis. In his book, Cure Aches and Pains through Osteopathy, Dr Modi quotes from Dr Still's autobiography: "I asked myself a serious question. In sickness, had God left man stranded in a world of guessing? To guess what the matter was? To guess what to give and guess what the result would be? I decided then that God was not a guessing God but a God of truth. All his works were harmonious. So wise a God had certainly provided remedies for all illness."

Dr Manjit Sehmby, a resident doctor at Dr Modi's health resort that offers naturopathy and osteopathy, explains: "Osteopathy offers a drug-free alternative to ailments such as migraines, spondylosis, shoulder pain, elbow pain, sprains and fractures. All these ailments occur mainly because we neglect our bodies. A bad posture accompanied by stress and tension gives rise to pain in the shoulder, the neck or the head." Backaches, however, are most common. Citing an example, Dr Modi says: "A lady who was two months pregnant suffered from severe backache. She was brought to me on a stretcher. The doctors opined that she should undergo abortion as she would not be able to bear the pain for the next seven months." But a few sittings with him and the pain disappeared.


A classic example of the wonders of osteopathy is the case of former Indian cricketer Dilip Vengsarkar. Dr Modi recalls: "In 1976, Vengsarkar had been suffering from severe back pain and was out of the game for nearly six months. Doctors suggested that he undergo a slip disc operation.

But he opted for osteopathy. After 6-8 sittings, he started playing again." A cricket fan himself, Dr Modi has recently written a letter to star Indian cricketer Sachin Tendulkar pointing out the benefits of osteopathy: "When Sachin was suffering from backache, he was given painkillers, laser treatments, and made to play. The best treatment is to allow him to rest."

BACKBONE CARE

Do not twist the body while turning. Instead, change the position of your feet and turn.
Just bending down and turning to one side should also be avoided.

When you want to lift any heavy object from the ground, do not stoop. Sit and lift the object.
Sleep on a hard bed covered with a carpet or a bed sheet.
Drink lots of water to flush the kidneys.


According to the doctor, osteopathy recognizes the structural abnormality of the spine and aims to normalize mechanical defects. But when this is not possible, it enables the body to adapt itself to structural weakness. "When we manipulate the spine," says Dr Modi, "we are not so concerned with putting the bone back into place as with removing the mechanical hindrance, if any, and restoring normal movements in the joints."

In osteopathy, manipulation is usually done in four ways. "The direct method," says Dr Modi, "involves applying pressure directly on the spine. Chiropractors generally use this maneuver. The second method is where the manipulation is done indirectly through levers formed by hands, shoulders, pelvis and legs. No pressure is exerted directly on the spine. Instead, the patient is properly positioned and the osteopath manipulates in all directions. In the semi-indirect method, pressure is applied to the manipulated segment with the help of the hand, knee or the chest. Another method involves exerting constant pressure in the cranial region."

Chiropractic, too, is a form of manipulative treatment. Says M.L. Kapoor, Mumbai-based chiropractor: "Chiropractic manipulations aim at removing disturbances within the nerves that stop proper circulation. And the pressure is usually applied with the help of knuckles." The healing power of nature then takes over, for, as Kapoor points out, chiropractic is essentially based on the philosophy of self-healing.

"However, chiropractic existed in India long before the West discovered it," reveals Kapoor. "It was passed on from the guru to the pupil for several generations." A retired government official, Kapoor learned this technique from his wrestling coach at Peshawar. After Partition, he came to Mumbai. Since then he has been treating people free. Chiropractic cures ailments ranging from sinus, headaches to slip disc and muscular dystrophy. "Though," qualifies Kapoor, "you cannot cure polio totally, people suffering from slip disc are plenty and chiropractic is a perfect cure for them." Kamini Mathur, a former patient, says: "I was suffering from a slipped disc. But a few sittings of chiropractic, followed by a strict diet regime, has made all the difference." Anuradha Waghdhare, a housewife, says: "I suffer from sciatica and have recently started chiropractic. Nonetheless, the pain has decreased tremendously."

Both chiropractic and osteopathy differ only in the form of manipulation—and in the fact that osteopaths are medically qualified.

But manipulation has been an age-old technique for setting bones. Bonesetters existed in almost all parts of the world. Even Sushruta, the legendary Indian surgeon, used manipulation on several occasions, recorded in his treatise on bone treatment, called Asthichikitsa.

An interesting tale goes that when Dr Corvisort, the physician-in-chief of Napoleon, was summoned to relieve the Emperor of lumbago, he asked Napoleon to disrobe and lie across a table. He then administered a well-aimed slap on his hips. The stunned Emperor turned in fury towards his doctor, but during this movement the painful contraction of his lumbar muscles disappeared.

The moral of the story? It only needs a twist or two from safe hands to keep yourself straight and running all your life.

Excellent Website for Osteopathic Medicine Treatments

Please visit:

Center for Sports and Osteopathic Medicine

An excellent website!

Many Thanks to Richard M Bachrach, D.O., FAOASM.

Somatic Dysfunction and Osteopathic Medicine

Source: Copyright © 1996-2003 Dr. Richard M. Bachrach
317 Madison Avenue, NY 10017 - 212-685-8113
http://www.bonesdoctor.com/index.html

I’m sure many of you have looked at the diagnoses on your itemized medical bill and expressed that very sentiment, perhaps in more colorful language. The problem may be twofold:

1. In the presence of pain and/ or fear, it is extremely difficult to absorb a lot of semi-technical information often couched in unfamiliar language.

2. We may occasionally be unable to find the specific key words to open the diagnostic doors for you.

What we have, in other words, is a failure of communication. This can be very upsetting to the therapeutic relationship. The following are some frequently used diagnostic terms in a neuromusculoskeletal practice and their explanations.

I Somatic dysfunction: impaired or altered function of the related components of the body framework, resulting in pain and abnormal motion, usually decreased. The term is used most commonly in this practice in reference to joint motion. However, somatic dysfunction involves changes in all tissues in the area: skin, muscles, ligaments, fascia, tendons, nerves, blood vessels, with or without radiation to a more remote site. Some of the most frequent areas of involvement in our practice:

A. Cervico-thoracic spine (neck and upper back) or lumbo-sacral spine (low back): There is a loss of normal movement between the vertebrae. This may be produced by abnormal muscle pulls resulting from trauma, chronic poor posture, stress, too little, too much or inappropriate exercise.

B. Sacroiliac joints: These are the large joints connecting the two halves of the pelvis to the sacrum (the triangular bone at the base of the spine). Motion at these joints is slight (according to some of our less enlightened colleagues, non-existent) but essential to the normal weight-bearing and movement functions. This condition is commonly caused by trauma and/or muscle imbalances and may produce pain in the buttock, low back, hip and/or thigh.

C. Trauma, abnormal muscle pulls and stresses may produce somatic dysfunction of any other body tissue.

II Psoas Dysfunction/Insufficiency Syndrome: Characterized by tightness of the primary hip flexor muscle, the psoas major, associated with forward tilting of the pelvis, tightness of the hamstrings and weakness of the abdominal and buttock muscles. This syndrome along with the ligamentous laxity associated with aging, injury and/or poor posture, commonly contributes to dysfunction at the sacroiliac joints, with consequent pain and disability. It may also be a precursor of:

III Intervertebral Disc Disease: Intervertebral discs are the cushions between the bodies of the vertebrae. They function as shock absorbers and enhance flexibility. The fibrous cartilaginous outer ring becomes frayed and stretched. The gelatinous nucleus within may push against it, bulge or protrude through it or even break through to press on one or more of the spinal nerves exiting the spinal canal between the vertebrae. This may produce radiating pain numbness or weakness in the involved leg. Long-standing disc disease eventually results in disturbance of normal mechanics with arthritic changes in the small spinal joints, thickening of ligaments and finally narrowing of the spinal canal through which the spinal nerves travel, a condition called:

IV Spinal Stenosis: characterized by back and/or leg pain occurring while standing or walking, and relieved by sitting. As the condition deteriorates, the distance the patient is able to comfortably walk becomes progressively shorter and the patient tends to lean forward. The pain will frequently cause early awakening from sleep. It is typically severe upon attempting to get out of bed in the morning

V Myofascial pain syndromes: Muscles, and, indeed, all cells, tissues and organs are lined, covered and invested with a tough connective tissue called fascia. Fascia is three-dimensional and is continuous throughout the body. Anything affecting fascia in one area is manifested to some extent in all body regions.

Repetitive micro-trauma (injury), unresolved single injury, inflammation, poor posture or maladaptive movement habits at play or at work, stress, lack of sleep or any combination of the above will produce tightness or abnormal contraction of skeletal muscles. The investing fascia becomes taut and bound down. Circulation to and from the muscles is decreased, resulting in the accumulation of the end-products of muscle metabolism, particularly lactic acid and potassium ions. Localized areas of muscle tenderness called trigger points are formed. These trigger points are extremely sensitive and fire impulses under the slightest provocation such as pressure and stretching, to distant tissues. This produces pain and consequent loss of motion at remote locations. Toxins accumulate, muscles and fascia tighten, pain increases. The myofascial pain cycle is perpetuated.