New Osteopathic Medical School Announced!

Source: LMU makes plans for College of Osteopathic MedicineKingsport Times News, TN - Jan 18, 2006


Yet another opportunity to learn OMT!

Lincoln Memorial University officials have announced plans to open a College of Osteopathic Medicine at the college's main campus.
LMU has notified the Southern Association of Colleges and Schools' Commission on Colleges (SACS COC) of school officials' intent to seek accreditation and award doctoral degrees in osteopathic medicine.
The new program will become LMU's first level 5 doctorate-level degree program. Approval is required from both SACS COC and the American Osteopathic Association's Commission on Osteopathic College Accreditation (AOA COCA) to achieve regional and professional accreditation of the program, said LMU spokeswoman Kate Reagan.
The decision to pursue the osteopathic medicine program was made after a feasibility study was done.
LMU first submitted a letter to AOA COCA requesting applicant status last summer, Reagan said.
"Following the completion of an exhaustive feasibility study by the university ad-hoc steering committee, the LMU Board of Trustees voted unanimously to support the development of a College of Osteopathic Medicine," she said. "A pre-accreditation application was accepted, and the university was evaluated by a visiting team from AOA COCA on Oct. 13, 2005."
Pre-accreditation status was granted to the university in December.
Recruitment of students will begin following final accreditation from SACS COC and AOA COCA.
LMU officials set the fall semester of 2007 as a target date for the beginning of classes, Reagan said.
The new school of medicine will be on LMU's main campus in Harrogate.
The first two years of the program will be offered at the main campus, Reagan said. But students will spend most of the last two years working in health care agencies in a corridor extending from Harrogate to Chattanooga. The bulk of clinical training will be conducted in Knoxville.
"Establishment of this College of Osteopathic Medicine will have a significant economic, health care and educational impact on the region," said LMU President Nancy B. Moody. "The growth that will occur as a result of this program will be felt far and wide."

Tennis Elbow Treatment and Osteopathic Manipulative Treatment Book Pick

Source: www.tendonsligaments.com/main.html

About the Book

Tendon and Ligament Healing
By William Weintraub, M.S.
236 pages58 illustrations and photos.
Second revised, expanded edition, 2003 Paradigm Publications 7" x 10" 236 pages Price: $22.95, trade paper ISBN: 0-912111-73-9 Distributed to the book trade by Redwing Book Company

Here is a clear, solid basis for non-surgical recovery from high numbers of chronic, unyielding sports and work injuries with the author's new hands-on osteopathic-style approach that is a breakthrough in tendon and ligament healing. It will hold strong interest for athletes and all active people, therapists, sports/movement trainers, and people seeking effective health care options.

The book features thorough case accounts of recovery, guidelines for self-care and sports injuries, dynamic research in the field, and illustrates techniques of this innovative low-force treatment. Serious ligament or tendon injuries are usually thought to have no hope of recovery without surgery, which has had very mixed results.

"This is an important publication because of the skills, light and optimism it brings to chronic tendon/ligament injury. Weintraub escapes a certain pessimism inherent in the standard treatment in this area, and he offers new possibilities for therapists and patients alike when dealing with these difficult problems, with his effective approach." -- Fritz Frederick Smith, M.D., founder, Zero Balancing; author, Inner Bridges

"an in-depth and impressive review of connective tissue dynamics. Weintraub's case reports allow the reader to follow a step-by-step process of his evaluation and treatment procedures resulting in a successful outcome where traditional rehabilitation approaches have failed." -- Sandy L. Burkart, Ph.D., P.T., past President, Orthopaedic Section, APTA

"Bill Weintraub is a skilled practitioner, his patients call him a true healer. I consider Bill an invaluable resource for the people we see in Dancemedicine, many of whom need help with serious tendon and ligament problems. -- Diana Herold, Dancemedicine Supervisor, St. Francis Memorial Hospital, Center for Sports Medicine

This book illustrates the innovative treatment model that Weintraub has developed for these injuries.

17 thorough case accounts and an illustrated technique section demonstrate this low-force manual method for a variety of injuries, avoiding surgery while promoting full recovery.
The book aids people's involvement in their own healing process through its many useful suggestions.

"As a practicing orthopaedic surgeon, I find Bill Weintraub's approach to chronic tendon/ligament injury to be innovative and refreshing. In his synthesis of conventional and complementary wisdom Weintraub has created a valuable new approach to the manual therapy methods for handling recalcitrant inflammatory processes. -- A.B. Flick, M.D., Dipl. American Board of Orthopaedic Surgery, American Academics of Pain, Wound Management
Weintraub has written a synthesis of recent scientific research on connective tissue which reveals a more potent healing response of tendons/ligaments than found in standard medical theory.

It provides insight into the training and essential attributes of the therapist.
"Bill Weintraub has written this book with the careful, comprehensive attention with which he approaches each of his patients. His creative intelligence and subtle hands-on mastery make this an essential book for clinicians treating and persons suffering from chronic tendon and ligament injuries who believe that if they only knew how, healing is a natural process. -- Bonnie Bainbridge Cohen, O.T.R., founder, Body-Mind Centering; author, Sensing, Feeling and Action

"Bill Weintraub, M.S., is at the same time an excellent therapist and a researcher who has produced this very valuable, clear, highly interesting work in the area of tendon/ligament treatment. -- Jean-Pierre Barral, D.O., Chairman, Dept. of Manipulation, Faculty of Medicine, Paris du Nord; author, Visceral Manipulation I and II, The Thorax

Tennis Elbow Treatment and Osteopathic Manipulative Treatment Exercises

Source: www.injuryicanhelpyou.com/ directory/tennis-elbow-injury.html

Tennis Elbow Treatment

Tennis elbow is the common name for the inflammation of the tendons (also know as tendonitis ) attached to the lateral, or outside, of the elbow at the bony bump of the humerus. ( upper arm bone ). The medical term for this bony prominence is called the lateral epicondyle, which is the reason that the condition is also refered to as 'lateral epicondylitis'. The muscles that move the wrist and fingers attach to a tendon that is connected to the bone structure in this area. Tennis elbow patients suffer experience pain on the outer or top part of the elbow. This pain may be experienced farther up the forearm and occasionally even in the hand. The pain is felt during grasping activities and may be accompanied by a feeling of weakness. Sufferers may have an dull ache in the area that is present at rest or at night after activity. Once the tendons become irritated and inflammed is it difficult for them to heal on their own because these tendons are constantly used every time the hand grips or squeezed anything.


Tennis Elbow Causes

Tennis elbow treatment ( lateral epicondylitis ) may result from a sudden violent injury. Repetive Stress Injury ( RSI ) is a much more common cause of tennis elbow because the constant repitition 'overload' the tendons beyond their ability to repair themselves. This repetive stress could come from motions in sport or at work, or even from a change in one regular activity. Such a change could be the result of playing more tennis than usual that results in lateral epicondylitis. A weekend of gardening, tinkering with tools or even opening a very tightly shut jar could lead to an instance of tennis elbow. The key elements seems to be any activity that involves constant squeezing or gripping. A similar condition can occur on the inside of the elbow. This condition is know as medial epicondylitis or 'Golfers elbow' ?

Is Tennis Elbow a serious condition?

Tennis elbow may be painful, it usually does not lead to serious problems. However, if the condition is untreated or becomes very painful, the patient could experience loss of function and loss of motion at the elbow. Tennis elbow treatment in these cases may be a little more difficult, rarely does it result in long term disability.

Tennis elbow is primarily considered a Repetitive Stress Injury( RSI ), the first course of action is to rest the elbow so that it can begin to heal itself.

If you are suffering from tennis elbow, you should first try to identify the movement causing the inflammation. Sometimes this is simple. If you are an avid tennis player, then swinging a tennis racquet is the most likely culprit.

Think about what activities you were involved during the time that you first notices the tennis elbow pain. The most common movements leading to tennis elbow are repetitive motions and/or very strong gripping movements, squeezing objects and heavy lifting.

Myofascial Release and Craniosacral Therapy

Source: www.wolfgangluckmann.com/ myofascial-craniosacral-accuprin.htm

Myofascial Release and Craniosacral Therapy are effective in the treatment of:

Myofascial pain
Headaches and migraines
Fibromyalgia and other connective-tissue disorders
Chronic fatigue syndrome
Women's health issues
Pelvic and menstrual problems
Acute and chronic pain
Chronic neck and back pain
Carpal tunnel syndrome
Temporomandibular joint syndrome (TMJ)
Restriction of motion
Post-traumatic stress disorder
Post-surgical dysfunction
Stress- and tension-related problems
Attention deficit disorders
Repetitive stress and sports injuries
Rehabilitation
Scoliosis
Orthopedic problems
Neurological dysfunction
Autism
Central nervous system disorders
Traumatic brain and spinal cord injuries
Infantile disorders
Colic
Learning disabilities
Emotional difficulties
Neurovascular or immune disorders

Search this blog for more articles

Correct Posture, Osteopathic Medicine, DOs are the source of leading expertise in helping patients improve their posture and spine health.

Source: www.healthlibrary.com/reading/ncure/cure/chap6.html
www.indiangyan.com/books/therapybooks/ Osteopathy/Adopting_Correct_Posture.shtml


'My bed is so cozy, nice and soft. When 1 sleep I sink into it, I am in a dreamland and I feel wonderful and so fresh in the morning. I love my bed, it is so dear to me.' 'Disgusting!' said the osteopath.

'I have never played any game in my life. When I was young I entertained myself with novels and movies, or kept myself busy with my course books; I was a bookworm. When I got married, I hardly had any chance to participate in games. My house is well equipped with modern gadgets and amenities so that I hardly exert myself physically.' 'Frustrating!' said the osteopath.
'I was tall with good features, but since I was tall I could hardly hold myself erect. This was also due to the natural instinct of a teenaged girl. I gradually developed a habit of walking and sitting with a forward stoop. I cannot change it now.' 'So unmindful!' said the osteopath.

'If you go to Rajasthan, watch the ladies carrying a number of water pitchers on their heads. They walk miles and miles to bring water for the cooking and daily washing. It is a pleasure to see them walking. They walk so straight and their walk looks so very graceful.' 'Wonderful, it is healthy!' said the osteopath.

'Do you see boys making pyramid formations in a circus or on the streets of Bombay to bring down the pitcher hanging high and tied to a rope on janmashtami They make human pyramids, one boy over another, to reach the top to break the pitcher. Only a team of healthy and stout boys with straight backs can play this game and succeed ‘ .‘It must be very interesting and so healthy!' said the osteopath.

'We live in a village and our work involves hard labor in the fields and at home. When we are young we go to the akhada to do dand-baithak and wrestling. We perspire, we rub mud on our bodies, we take a swim, we feel fresh and fine. We cannot afford thick mattresses, so we just spread a little rug on the ground and fall into a dreamless sleep, only waking up in the morning. We feel fine and energetic; we feel like pushing and -punching somebody.' 'You have the healthiest habits in the world!' said the osteopath.

At the London College of Osteopathy, we used to hear an interesting story about a man called Frederick Matthias Alexander. He used to cure his patients of their aches and pain, only by teaching them how to stand and sit correctly and how to do different activities using the correct posture. He cured his patients just by correcting their posture! This may appear very surprising, but it is true. Osteopaths are very careful about the posture of their patients. They tell their patients how to correct their posture and do corrective exercises, so that once they are- cured of their ailment, it will not recur. Medical men today are conscious of the role that posture plays in the etiology of different diseases.

It is very important to know how one should carry one‘ s body. A humped back and vertebrae contracted together cause back pain. The neck sunk down on the chest causes stiffness in the neck, pain in the arm and headaches. When we stand erect, how many of us put equal pressure on both the legs? All the body weight is usually put on one leg, putting a constant strain on the pelvis and lumbar spine. Bad posture keeps our muscles tense.

How many teachers or parents are watchful of their child's posture? The correction of posture in a child is much easier than in grown-ups and elderly people. Healthy habits developed by a child help him right through his life. As parents or teachers, we should be conscious of how a child sits and if the posture is incorrect, we should point it out to him and take care to keep on correcting it. It is very important to see how a child sits, reads, writes, walks and plays.

Spinal curves are absent at birth and during the first few weeks of life, there is one continuous curve as the child is curled up in the womb. This primary curve undergoes changes as the child grows and lifts up his head, tries to sit, crawl, stand, walk and run. At the age of three months when the child tries to lift his head and look around, the upper secondary curve in the spine - from the first cervical to the first dorsal vertebrae - starts developing. By nine months when the child is able to sit, this curve is convex forward.

The lower spinal curve (lumbar) from the first lumbar to the fifth lumbar vertebrae appears between twelve to eighteen months when the child tries to walk. It is more prominent in females than in males.

The thoracic curve from the second to the twelfth thoracic vertebrae is concave forward. The pelvic curve from the lumbosacral joint to the coccyx faces downwards and forwards.

The primary thoracic kyphosis (bending forward at the thorax) present at birth is maintained; the cervical and lumbar lardosis (bending backward at the lower spine) are developed during the process of growth, so that man can assume an erect posture.

Biologically speaking the lumbar and cervical (neck) curves emerged after man acquired an erect posture during the evolution of human life.

Mechanically these curves are so constructed due to the structure of the vertebrae, that they are maintained even when we lie on the floor or an extremely hard bed. If these curves are excessive, they are a causative factor for different aches and pains. For example, the spinal joints most vulnerable to internal derangement are between the fifth and sixth cervical, and fourth and fifth lumbar vertebrae - the area of the spine where the cervical and lumbar lardosis is most marked.

From early childhood every effort should be made to prevent future backache. Back pain is a universal symptom. So the aesthetic consideration of a child's posture and mechanism of disc protrusion should be a consideration before selecting exercises for children. In adulthood when disc degeneration has already started and the spine is comparatively stiff, exercises suddenly forcing a person to bend forward should not be included; if included at all, enforcement should be gradual, so that the spinal ligaments are able to retain their elasticity and undue damage is not caused by sudden force. A patient with back pain should not be advised to do forward bending exercises. Sometimes even when a sufferer from back pain finds that flexion exercises increase his discomfort, he is asked to do these exercises. Amy exercise which aggravates pain during or after it has been done, is harmful. It is a symptom of injuring a sore spot and healing of the pain is delayed by such exercises.

Selecting the Right Bed

While selecting a bed due importance should be given to posture and spinal anatomy. Most people are not aware of these considerations. In fact, with affluence and luxurious living, things are changing for the worse rather than the better. Cotton mattresses are being replaced by foam mattresses. The thickness and number of pillows used by an individual are increasing. Springs are often added beneath these foam mattresses. A comfortable bed is considered to be one into which you sink in. Is that correct? Very definitely not!
It is important to keep the spine as straight as possible while sitting, standing or doing any job. Equally important is to help the spine to remain as straight as possible while lying in bed, and even more so when you are suffering from back pain or neck pain.

Let us consider what a soft bed does to your spine. When you lie on a soft bed the heavier part of the body sinks deeper into the bed, and the lighter part of your body stays up in bed, thus increasing the curvatures of the spine and putting a lot of undesired strain on it. Thick pillows worsen this situation. The thicker the pillow, the more you flex your cervical spine, which is again an unnatural strain.the lumbar lordosis to be maintained in a position of maximum comfort.

The best remedy for your tired back after a whole day's work is to lie down just for a few minutes with your back flat on the ground and you will feel relaxed.
Buddhists in ancient India lived in a monastery which consisted of a large hall with small rooms all around in the monastery. These rooms were often made by digging into big rocks, and stand to this date. Beds were also made by cutting into the rocks; these were for meditation and for the monks to sleep on.

There is an interesting sb1oka in Bhav Prakash by Rajeshwar Dutt Sashtri. This is one of the most authentic books on ancient Ayurveda.vata, the energy which can get stuck in any part of the body and cause pain. Charaka, a famous teacher- of Ayurveda, mentioned that 'the person who feels lazy due to discomforts in the body, and wants to sleep, should sleep on a somewhat hard bed' (asukha shaiyya).

When a person changes from a soft to a hard bed, he feels a little discomfort and slight, stiffness in the beginning, but this phase passes off quickly'an4 he later feels comfortable and relaxed.
A person who is healthy and does not have any back problem should have a bed with a solid base and a comfortable mattress, two to three inches thick. It can even be a foam mattress which is one inch thick. If there is a spring in the mattress, a wooden board should be placed on top of it and then a thin mattress. A patient with a spinal disc problem should be provided with a harder bed.

If pain and stiffness are felt after a night's sleep, it is an indication that the bed is faulty. During sleep, the muscles are relaxed and all the strain is tolerated by the ligaments. When these ligaments are stretched for a long time they start aching. This indicates that the bed is wrongly constructed and in spite of relaxing the spinal ligaments, it makes them taut, and pain is felt due to stretching of these ligaments.

Correcting Your Sitting Posture

Pain over the dorsal spine is very rarely due to a slipped disc. It is mostly due to the searing strain on the posterior ligaments of the spine, following a wrong posture. Due to the chronic habit of standing or sitting with a forward stoop, the patient develops a round back. This long-standing strain on the back weakens the spinal muscles. As the muscles are not able to take the strain, the strain passes on to the ligaments; and as the ligaments are continuously stretched for a long period, the body's compensation breaks and you start having back pain. When a patient has dorsal kyphosis, the site of the vertebrae placed at the summit of the dorsal curve feels most painful after fatigue. This pain may also radiate to the chest, shoulder and back. The cartilage of the disc is insensitive since it has no nerve supply and, therefore, the first sign of disc damage is due to the stretching of the supporting ligaments.

The prolapsed disc may bulge and stretch the posterior ligament. A thin disc leads to narrowing of the space between the adjacent vertebrae of facets, with a consequent strain on the ligament which causes pain.

Have you observed the statues and paintings of Buddha at Ajanta and Ellora? Buddha is always shown sitting in yoga mudra with his spine straight. Yoga mudra is the sitting posture for meditation. This posture frees the body from any strain on the spine so that it does not hurt and divert the attention of the person who is meditating. This posture has to be maintained for hours and therefore, it should be comfortable, and free of any pain or strain.

Yoga asanas called posture exercises were developed in India in ancient times, and were practised for generations. Asanas are taught by Yoga teachers to patients suffering from back pain; they take the form of back extension exercises.

A simple set of exercises of dand baithak practised in the villages of India has a beneficial effect on the spine. It takes off the strain from the spine and makes it fit to fight the other strains on the spine caused by the adoption of an erect posture.

To sit slumping in a low chair puts considerable strain on the lower back. If the posture of sitting is not correct any measure to relieve the low back pain will not be effective. The patient should sit right at the back of the seat and then rest against the back of the chair. An ordinary office chair is much better than a sofa. If the cushion is not of a proper design, a small pillow may be placed behind the small of the back.

While designing furniture - be it a bed, kitchen shelves, or cupboards - keeping in mind the right posture is important. As an osteopath, I remember being paid a big fee for designing the chairs for the British Airways aircraft.

Strengthening Muscular Control

Exercises are needed to tone up the muscles and to maintain a good posture. Slack muscles lead to poor posture and undue strain is passed on to the ligaments. Eventually ligaments stretch and further abnormal mechanical strain produces still more symptoms.

Poor muscle tone is inevitable if the number and kind of exercises done are insufficient. A person with poor muscle tone is much more vulnerable to mechanical strain than one with a normal or muscular build.

An office worker, for example, whose spinal muscles are slack and weak due to his unstrenuous job, is much more vulnerable to strain or sprains if he tries to lift something heavy or do gardening. On the other hand, a person who does his exercises daily or participates in games has muscles which are in good shape. The following example will give a complete picture:

When a person is ill and completely inactive in bed, he loses the strength of the muscles at the rate of 7 per cent a day.

To increase the power of the muscles, exercises should be chosen wherein two-thirds of the maximum muscle strength is used.

To maintain the strength at the same level, one-third of the maximum strength should be used.
The power of the muscles decreases if only one-fifth or less of the maximum muscle power is used.

Increase in firmness and tone of the muscles is the indication of increase in muscle power. To acquire hypertrophy of their muscles, weight lifters and body builders exercise their muscles to a point of considerable fatigue. Hypertrophy of muscles is not necessary for healthy living.
The muscles should not be forced beyond a certain limit. If they are exercised beyond the tolerable muscle limit, they cease to contract in spite of maximum mental effort, and become inflamed, swollen and tender to touch. The subsequent
contraction of muscles is painful for two to three days.


Mobility of the Spine

The intervertebral joints of the spine can be hypomobile (less mobile) or hypermobile (more mobile).
A hypermobile joint with elongated weak ligaments is more vulnerable to disc lesion. Hypermobility leads to impaired nutrition, and then degeneration and softening of the disc. In this case, as the supporting ligaments of the annulus fibrosus are weak, herniation of the disc is inevitable. Hypermobility also leads to injury and tearing of the ligaments, and when there is a prolapsed disc, it takes much longer to heal, as giving support and rest to these joints is difficult.
An incorrect lifting posture is the reason why we sometimes get vertigo or giddiness due to disturbances in the upper cervical spine. A faulty posture and gravity impede the return of blood to the heart. If a faulty posture is maintained for a long time, blood congestion takes place and difficulty in breathing may be experienced. The central nervous system depends upon the integrity of the spinal column. All the impulses coming and going between the brain, spinal chord and peripheral nerves have to pass through the intervertebral foramen which can be very easily disturbed by a faulty posture, and can, in return, affect any part of the nervous system. Certain precautions must be taken to avoid a strain on the spine.


* When you want to lift something heavy from the ground or bathe a child, or make the bed, do not stoop; sit and lift the baby for a bath.
* Do not twist the body while turning, but rather change the position of your feet and turn. Just bending down and turning to one side is the worst movement you can make.
* Do regular back-extension exercises and abdominal exercises to keep up the tone of the muscles.

To current DOs and osteopathic medical students: Does OMT Have Proved Benefit? Yes and many old osteopathic physicians know about the efficacy of OMT

Source: www.jaoa.org/cgi/content/full/105/11/496

"I think I know the main problem that the osteopathic medical profession faces today. After graduation, too many DOs intern in hospitals were OMT is never practiced, never mentioned, and, in some cases, even prohibited. So these poor, partially educated DOs never really get an opportunity to use OMT as it should be used. "

Here is an excellent article which shows what current DOs should do (consult currently practicing physicians who have incorporated OMT into their practice in their practice)

For example, check out what the osteopathic physician had to say about incorporating OMT into his practice.

"When I retired in 1988, I had 53 years and 5 months of clinical experience as an osteopathic physician—perhaps the most extensive general practice in Minnesota—and I had administered OMT an estimated 400,000 times. These treatments were my main therapeutic procedure. The fact that so many people drove daily 20 to 120 miles for my OMT sessions indicates to me that no expensive trials of OMT are necessary. All that needs to be done to verify the efficacy of OMT is to consult old timers such as myself! "

Please visit: Osteopathic Manipulative Treatment Out of a Horse and Buggy

Some quick facts about osteopathic medicine!

Source: www.healthywomen.org/content. cfm?L1=3&L2=102&L3=4.0000

Although osteopathic medicine started out as a drug-free approach to the practice of medicine, the vast majority of doctors of osteopathic medicine will prescribe medication as needed.

By combining all other medical and surgical therapies with osteopathic manipulative treatment (OMT), doctors of osteopathic medicine (DOs) offer their patients more—a comprehensive approach to health care—because they are taught to treat the whole person, rather than just a single condition.

Most DOs select careers in primary care—such as family practice, internal medicine, or pediatrics, while others practice specialties such as obstetrics and gynecology, surgery, and emergency medicine. Many practice in rural and low-income areas.

Andrew Taylor Still, DO, MD, the father of osteopathic medicine, developed the specialty in 1874 after becoming disillusioned with the practices of medicine. He wanted to reform the practice of medicine but ended up developing a new branch of it altogether.

Your DO will address various lifestyle factors during diagnosis and/or treatment, such as stress, diet, exercise and posture.

OMT is considered extremely safe but is unadvisable for certain conditions, including bone cancer, bone or joint infection, a protruding disk or osteoporosis. OMT is not advisable if you've had spinal-fusion surgery.

One form of OMT is cranial sacral osteopathic manipulation; this approach involves OMT applied to your head using gentle, rhythmic pressure. If this is something that interests you, ask for the specialist in this area.

Myofascial Release

Source: www.terrarosa.com.au/define.htm

Myofascial Release principles:

• Fascia covers all organs of the body, muscle and fasciæ cannot be separated
• All muscle stretching is myofascial stretching.
• Myofascial stretching in one area of the body can be felt and will affect the other body areas.
• Release of myofascial restrictions can affect other body organs through a release of tension in the whole fascia system.
• Myofascial release techniques work even though the exact mechanism is not yet fully understood.
  

The indirect myofascial release techniques are as follows:

• With relaxed hand lightly contact the fascia.
• Slowly stretch the fascia until reaching a barrier/ restriction.
• Maintain a light pressure to stretch the barrier and wait for approximately 3-5 minutes.
• Prior to release, the therapist will feel a therapeutic pulse (e.g. heat).
• As the barrier releases, the hand will feel the motion and softening of the tissue.
• The key is sustained pressure over time.

Osteopathic Manipulative Medicine For Ulnar Neuropathy by William H. Stager, DO

Source: satsop.olympus.net/biz/medicalacupuncture/ aama_marf/journal/vol14_3/case4.html

ABSTRACT

Background

Peripheral neuropathy is a common condition with a variety of possible causes and treatments.

Objective

To describe the use of medical acupuncture and osteopathic manipulative medicine (OMM) in a patient with traumatic ulnarneuropathy.

Design, Setting, and Patient

A 51-year-old man with left ulnar neuropathy due to accidental severing of the ulnar nerve at the elbow; following surgical repair, he reported muscle weakness, pain, and paresthesias.Intervention Acupuncture points PC 6, HT 3, LI 4, LI 10, SI 3, SI 8, and TE 5 were selected on the patient's left arm and hand, along with various adjunctive points in response to signs and symptoms. Osteopathic myofascial release techniques were integrated with the acupuncture program (40-minute treatment sessions every 2-3 weeks).Main Outcome Measure Ulnar sensory and motor improvement.Results The patient's symptoms improved after the 1st treatment. He was treated for 4 years with continued improvement, including 50% decrease in pain and 50% increase in range of motion.Conclusion Combined acupuncture and OMM demonstrated efficacy in the treatment of this patient with traumatic ulnar neuropathy.


INTRODUCTION

Peripheral neuropathy is a common condition that affects millions of people in the United States annually. Its causes can include trauma, tumors, infections, diabetes and other metabolic diseases, vascular insufficiency, nutritional deficiencies (such as beriberi and pellagra), motor neuron diseases, and toxic exposures such as lead.1 Clinical manisfestations and symptoms can include pains of every degree, weakness and muscle wasting, and paresthesias such as numbness, tingling, and burning. Numerous treatments provide varying degrees of success, including acupuncture, osteopathic manipulative medicine (OMM) techniques, pain medications, and surgery.1 Case ReportA 51-year-old Florida man presented 4 months after accidentally cutting his left elbow. The cut was deep and completely severed the ulnar nerve where it is most superficial at the elbow joint. He underwent surgery that same week and the nerve was reattached. After surgery, the surgeon gave a poor prognosis regarding recovery of the use of the patient's arm and hand in the ulnar distribution. The patient was prescribed hydrocodone/acetaminophen once at bedtime for pain. He also requested the integration of more natural methods. The initial postsurgical physical examination revealed a healthy man with the following abnormal physical findings: ulnar muscle wasting, weakness, paresthesias of tingling, numbness, and burning, and a "claw" or hooked 5th finger unable to move. The patient had a weak handgrip and strength (3/5), diminished sensation in the 4th and 5th fingers, a 3-in scar on the medial elbow, and myofascial restrictions along the arm, forearm, and hand. Hand abduction, adduction, and flexion, which are functions of the muscles of ulnar distribution,2 were all reduced. METHODSMyofascial Release TechniquesVerbal consent was obtained from the patient for combined myofascial release techniques (OMM) and acupuncture treatment limited to his left upper extremity. The myofascial release techniques were a combination of direct (toward a restriction) and indirect (away from a restriction) techniques.3 These gentle, slow-motion maneuvers either stretched or shortened the soft tissue (muscles, tendons, ligaments, and fascia) throughout the left shoulder, arm, forearm, hand, and fingers as restrictions were palpated, identified, and treated/released. These techniques are recommended standards of care for the relief of myofascial restrictions and neuropathies.3 They were applied before and after the acupuncture treatments to release restrictions, encourage circulation, and enhance the acupuncture treatments (10 minutes of OMM, 20 minutes of acupuncture, then 10 minutes of OMM within a 40-minute treatment period).Medical AcupunctureAcupuncture was performed with sterile, single-use, stainless steel needles, 0.22 mm in diameter and 25 mm in length (Helio Medical Supplies Inc., Santa Clara, Calif). Only the left upper extremity was treated at the patient's request. Several points were selected after careful examination and identification of the scar area, the ulnar nerve pathway, regional nerve and blood vessel distribution to avoid injury, as well as myofascial and joint restrictions. Needles were inserted 25 mm in depth, for 20 minutes per session, either in manual tonification (i.e., pointing in the direction of the flow of the meridian and turned clockwise, eliciting a De Qi response) or neutral technique (i.e., no turning of the needle nor eliciting a De Qi response). Acupuncture points were chosen to affect the sensory and motor symptoms resulting from the ulnar nerve damage. Acupuncture points PC 6, SI 3, SI 8, LI 4, LI 10, TE 5, and HT 3 were needled, with 1 to 3 other points sometimes added or subtracted from the above regimen depending on the patient's response, signs and symptoms, and physician's findings. Those extra points were SI 4, PC 4, PC 5, LI 11, LI 12, and TE 8; they were chosen on the basis of either point tenderness or relief from pain or dysfunction. Also, 1 to 3 needles were placed around the 3-in scar at the medial elbow area to increase circulation, decrease scarring, and complement the basic treatment prescription. Treatments were scheduled in response to the outcome of each session and averaged approximately once every 2-3 weeks over 4 years.Although all the points described have many indications, the major rationale for using them was that each can be used for local sensory or motor symptoms in their anatomical and energetic areas of distribution.4RESULTSThe patient's sensory and motor signs and symptoms improved significantly after the 1st treatment. When he returned 2 weeks later, he stated that he felt stronger, more energetic, with increased sensation, and less stiffness. Increased sensation included both restored feelings in the hand and arm as well as an increased ability to feel. The patient's hand and arm pains and paresthesias had decreased 50% based on patient report using a 1-10 scale and by palpation; hand range of motion and hand and arm strength improved approximately 50%. The treatment was effective over 10-20 days; consequently, maintenance treatments were scheduled every 2-3 weeks. The patient continued to improve over the next 4 years. The strength in his left upper extremity was almost normal with some intermittent paresthesias of numbness, pain, and tingling. The 5th finger remained somewhat flexed.

DISCUSSION

This patient presented with traumatic ulnar neuropathy after accidentally severing the nerve at the left elbow and then having it reattached surgically soon thereafter. His signs and symptoms included motor and sensory loss, pain, paresthesias, weakness, and stiffness. The surgeon pronounced a justifiably poor prognosis. Treatment was begun using a combination of acupuncture points and myofascial manipulative techniques. The acupuncture points were selected because of their known effects on the local sensory and motor signs and symptoms, as well as their energetic properties.4 Most of the points were found along the distribution of the ulnar nerve. Points were also chosen for their energetic value since pain is described in Oriental concepts as resulting from blocked or stagnant energy and blood.5The patient experienced both trauma and surgery, which would be considered cause for blockage, stagnation, or both.5 Yin points (PC 4, PC 5, PC 6, and HT 3) were chosen for their effects of increased circulation and decreased pain and dysfunction; Yin points also move the energy in the direction from the arm to the fingers. Yang points (SI 3, SI 4, SI 8, LI 4, LI 10, LI 11, LI 12, TE 5, and TE 8) were chosen for their positive effects on circulatory and neuromuscular signs and symptoms. Yang points move energy in the direction from fingers to elbow and arm. Local points encircling the scar were also chosen for their ability to increase or enhance energy and effects (increased circulation and decreased scarring).6,7 Myofascial manipulative techniques were also used before and after acupuncture to loosen the restricted joints, muscles, and fascia, which in turn increased ranges of motion and circulation, and decreased pain and dysfunction.3 The patient reported significant relief from his symptoms after the 1st treatment. A treatment schedule of once every 2-3 weeks was eventually used since some symptoms returned after longer intervals. The patient's sustained and increasing improvements justified the methods and schedule and greatly improved his prognosis.Both acupuncture and OMM techniques have been used separately for the successful treatment of a number of neuropathies. A wide variety of acupuncture and manipulative techniques have evolved and been interwoven by ancient and modern practitioners and are recommended in modern textbooks.6,7 The rationale has been to affect the peripheral and central nervous system neurotransmitters and endogenous opioids to modulate pain and nerve response, increase circulation, and relax and normalize the neuromusculoskeletal system.3,7

CONCLUSION

This case report demonstrated the combined efficacy of acupuncture and OMM in the treatment of ulnar neuropathy. Further research is indicated to optimize combined acupuncture and manipulative techniques.

REFERENCES
Weiner RS, ed. Pain Management: A Practical Guide for Clinicians. Boca Raton, Fla: St. Lucie Press; 1998.
Williams PL, ed. Gray's Anatomy. 38th ed. New York, NY: Churchill Livingstone; 1995.
Foundations for Osteopathic Medicine. Baltimore, Md: Williams & Wilkins; 1997:843-899.
Helms JM, Elloriaga-Claraco A, Ng A. Point Locations and Functions. Brookline, Mass: Redwing Book Co; 2002.
Guillaume G, Chieu M. Rheumatology in Chinese Medicine. Seattle, Wash: Eastland Press; 1996.
O'Connor J, Bensky D, trans-eds. Acupuncture: A Comprehensive Text. Seattle, Wash: Eastland Press; 1981:622, 626, 632, 656, 662.
Helms JM. Acupuncture Energetics: A Clinical Approach for Physicians. Berkeley, Calif: Medical Acupuncture Publishers; 1995.
AUTHOR INFORMATIONDr William H. Stager is in holistic private practice in West Palm Beach, Florida. He is Board-certified in Osteopathic Manipulative Medicine, Family Practice, Medical Acupuncture, and Pain Management.William H. Stager, DO, MS, DABMA*2617 No Flagler Dr, Suite 111West Palm Beach, FL 33407

Osteopathic Medicine and Treating the Common Flu: Use of osteopathic manual medicine aids patients in treating the flu virus

Source: www.vaccinationnews.com/picks_of_the_day_archives.htm

The Cranial Academy: Experts Revisit Successful Treatment in Worst Flu Epidemic in 1918 as Avian Flu Threatens


Census officials reported a startling recovery rate among patients, in the deadliest flu epidemic in history in 1918, had one thing in common: the same type of doctor.
"Traditional osteopaths" are long on evidence as the best-cited specialty in treating flu cases but short on public recognition of their non-invasive treatment -- osteopathic manual medicine (OMM). Still, the ability to help patients, osteopaths say, stems from the profession's unique training to effectively address the underlying abnormalities that cause illness, including influenza.
The point of treatment, especially in a flu virus, is to trigger the body's own natural healing mechanisms and increase immune response. "The congestion that flu causes predisposes the patient to pneumonia and sets up an environment in which the virus will proliferate," said Dr. Zinaida Pelkey, who practices OMM at St. Barnabas Hospital in New York. "By mobilizing the fluids and allowing the body's own immune system to function optimally you not only bring in cells that fight infection but clear away waste products of infection and inflammation."
Because their neuromusculoskeletal specialty falls into the category of physical medicine (hands-on treatment), the physicians and surgeons have been typically confused in the minds of their colleagues as practicing a modality in an unrelated field: chiropractic treatment.
This hasn't stopped health commissioners from making the distinction in the physicians' track record demonstrating that patients under their care experienced a shorter duration of flu, a lower incidence of pneumonia (a by-product of flu), and most important, a drastically lower mortality rate.
A study tracked 110,120 patients with influenza and determined that patients treated by osteopaths survived with a near zero, or 1/4 of 1 percent mortality rate, as compared with patients treated with conventional medications, which reported more than 20 times higher, or 6 percent mortality rate on a national average, according to U.S. Health Commissioners in 1919. The death toll was as high as 30 percent in some cities. The promise of a cure was also higher in cases of pneumonia: the death rate among patients treated with osteopathic manual medicine was 10 percent, compared to 30 percent among cases treated with conventional medications. Health commissioners collected medical records from 2,445 osteopaths treating patients in cities with populations of 40,000 or more across the country.
"The statistics are so drastically different in patients treated by osteopaths," said Dr. Pelkey. "We look at the flu today and we don't have much more to offer than people did back in 1918. We have antibiotics for infectious diseases but the flu is viral. We have some antiviral medications but they don't work for every kind of flu and may be contraindicated for some of the people at highest risk. So to have a form of medicine like osteopathy that essentially has no side effects and has been shown to be effective -- for all health conditions -- makes a huge difference."
Ironically the influenza epidemic in 1918 was recently identified as a "bird virus," a less fancy name than avian flu today. Despite the strange genetic mutation of the virus, osteopathic physicians maintain the same approach to treating dysfunction in the body caused by the illness.
Results to date are far from mixed and weighted heavily in favor of non-invasive medicine over conventional medication. There is evidence that the pendulum has also swung in the forum of public opinion, with more patients becoming interested in non-invasive treatment. Recently osteopathic medicine was cited as one of the fastest growing medical fields in the country, according to an article in the New York Times.

An Easy Way to Get Personalized Medical Care: Choose an Osteopathic Medical Physicians (D.O.s)

Source: www.ocregister.com/ocregister/ news/atoz/article_934357.php

The Morning Read: Bringing health home
Doctor takes a personal approach to patients, hauling his office to their living rooms.

This is not your typical doctor's office. The room is dim. The air reeks of stale cigarette smoke. When you sit on the sofa, a cloud of dust rises up. And the scale on the floor is 6 pounds off.
But today, for close to an hour, Bob Price's apartment in San Clemente is a doctor's office. Norm Vinn's office, to be precise.
You don't go to Vinn. Vinn comes to you. He is one of maybe a dozen physicians in Orange County whose business is making house calls.
While your family practitioner might squeeze in 20 to 30 patients a day, Vinn sees eight. While your family practitioner might see you for 15 to 30 minutes, Vinn listens for up to an hour.
"I don't want to get too weepy here," he says over a cup of steaming coffee at a booth at Denny's, his office this morning. But trading in his family practice for the slower-paced house-call track was a chance "to find some inner peace. And spiritual fulfillment."
He was sick of always being in "too much of a hurry to ask people about the book they're reading or their families," he says.
By 9 a.m. on most days, Vinn is finished surfing Lower Trestles and is driving to his first visit in his silver Lexus.
Today he stops on a street in San Clemente, fishes a stethoscope, doctor kit and miniature lab-test machine out of his trunk and walks up to the door of Apartment A with a knock and a holler. "Bob? It's Dr. Vinn!"
Inside, Bob Price is lying on his side in bed, his skinny legs barely covered by a loose blue hospital gown. There's no bottom sheet on the mattress. His feet are bare.
"No hair, no teeth, no aorta," is how Price sums up his condition. An aneurysm blew the aorta out and he's had prostate cancer for 11 years, not to mention "two bad hips and two bad legs," scoliosis, arthritis, a cold that won't quit, a rash, congestion and a creeping cataract.
But Price is an optimist. "Eighty-five and still alive!" he laughs.
Vinn "has been a godsend," Price says.
Price doesn't have a wife or children or a car, and even if he did own wheels he can barely hobble to the bathroom a few feet from his bed, let alone drive to a doctor.
He is the prototypical house-call patient. Medicare requires that it take "significant and taxing effort" for the patient to walk 100 feet before it will pay for a house call.
Vinn's patients include a young woman who was paralyzed in a freeway wreck and a man who can't get out of bed because he weighs more than 700 pounds. But most people he treats are in their 80s, trapped in their homes because their bodies are just calling it quits.
Just as often as Vinn discusses a patient's blood pressure, he finds himself discussing their mortality. Are they ready? How are they coping? "Candid, strange conversations," he says. If dementia is present, that conversation is often with the patient's spouse or children.
Because most of his patients are facing The End, the depression factor is one of the downsides of the house-call business. It brings to his mind the axiom: When you're a hammer, everything starts looking like a nail.
So when he starts feeling like everyone is dying, he takes off his red tie and white button-down shirt, puts on a wetsuit and heads to the ocean to put things back into perspective.
Vinn opened his practice in Long Beach in 1978 and enjoyed it until managed care came along in the '80s. The turnstile of patients, he said, became "very frustrating for patients and very frustrating for the doctors."
Vinn is an osteopathic physician, which means he treats the whole person. Besides diagnosing illnesses and treating symptoms, he counsels patients on nutrition and hygiene, addresses depression and loneliness, discusses financial hardships and even connects patients with social-service agencies.
In other words, he needs more than 20 minutes.
It got to a point where he was coming home at night to his wife and three daughters, "angry, irritable, frustrated, depressed. I wondered if I was a squirrel in a cage."
In 1998 Medicare began paying doctors more equitably to make house calls, Vinn says. The next year a colleague told Vinn about a doctor who had started a house-call business in San Diego. Vinn took a chance and joined the group. In 2002 he started his own business called Housecall Doctors Medical Group.
He brought in another doctor and three nurse practitioners and opened an office in Laguna Hills, but it's only used to store charts.
Not being chained to an office has its perks, but it also has a few hassles. Vinn puts 2,500 miles a month on his car driving to patients all over Orange County. He earns about 20 percent less than when he had an office practice. He meets medical officials in parking lots to sign death certificates and gets calls from patients at all hours.
The other night, a call came during dinner from a woman who got his number from a health-care agency. Vinn told her he was eating and would be there as soon as possible. By the time he showed up at her house, she said she was having her dinner and refused to let him in.
But most of the 350 patients in his practice are so appreciative, they practically gush.
Price says he is grateful that Vinn is simply around to talk to. And Price is quite a talker.
Now he is talking about how he never considered giving up smoking because he thinks it's therapeutic for people who experience depression. Vinn sticks a flu shot into Price's arm. Then he checks his prostate.
"Thank you, sir," Price says when it's done.
"Are you eating a lot? You look to me like your face is thinner," Vinn says.
"You think you can weigh me?" Price asks. "That's a good idea, doctor."
Price swings his legs around to sit on the bed. Then, leaning on his walker, he stands and steps precariously onto an old dusty scale that the doctor brought in from the kitchen. Letting go of his walker, Price balances for a few shaky seconds to put his full weight on the scale. It reads 127 pounds.
"I weighed 185!" Price says. "Well, stranger things have happened."
"Let's try it one more time," says the doctor.
The room is dim, maybe they read it wrong. "You want a flashlight?" Price asks.
Vinn says no but steps on the scale himself to check for accuracy. It's about 6 pounds light, he decides. When Price steps back on, it still registers 127. So he's probably 133 pounds, the doctor figures.
"Oh, man. If I had any sense, I'd be scared," Price says.
Six days later Price calls an ambulance to take him to a hospital in Long Beach. He can't manage his catheter anymore. Vinn gets wind of it, rings a San Clemente rest home and asks them to hold a bed for Price so he can bring him back to Orange County.
"That way Dr. Vinn can still look in on me," Price says. "Ya know. I think everything's gonna be fine."

Curing Shoulder Pain Using Osteopathic Manipulative Treatment(OMT) by DOs

Source: www.indiangyan.com/books/therapybooks/ Osteopathy/Curing_Shoulder_pain.shtml

'Doctor, I don't know what has happened to my shoulders. They ache a lot and the ache is gradually increasing. I cannot move them properly. It is becoming impossible for me to put on my clothes myself even combing has to be done by somebody else. The pain persists during the day, but at night it becomes worse. If somebody presses my shoulder joint, I get an excruciating pain. I have had all kinds of treatment but nothing seems to be helping me. Can you do something?'

The above symptoms seemed to point towards a frozen shoulder. This condition can be diagnosed easily. The shoulder joint is frozen and its mobility reduced. Before we go further let us examine what our shoulder joints are and what they do.

A shoulder joint is a ball and a socket joint. The head of the upper arm bone (humerus) and a shallow cup-like structure of the shoulder blade (scapula) make up this joint. The head is much bigger than the socket and only a part of the head can fit into the socket called the glenoid cavity. The socket is deepened by a fibrocartilagenous rim. Due to this arrangement, the shoulder has a better range of movement than any other joint in the body. But it is a weak joint and depends on the surrounding muscles for its strength.

The joint is covered by a sac-like structure, a fibrous capsule. This capsule is lax and the bones can be separated from each other for a distance upto half an inch. This can provide a further range of movement. The inferior part of the capsule is the weakest part. The movement at the shoulder joint is further increased by the movement of the shoulder blade itself When the arm is raised upto 1200, movement takes place at the shoulder joint and a further 600 is obtained by rotation of the shoulder blade. The acromio-clavicular joint at the lateral end of the collarbone (clavicle) and sterno-clavicular joint at the medial end of the collarbone also participate in shoulder movements.

In the case of a frozen shoulder, the capsule is thickened and retracted. This can be clearly demonstrated by orthography (taking an X-ray after injecting a radio-opaque dye inside the joint).

Why a frozen shoulder occurs is not known. There is a limitation of movement in all directions. It generally occurs between the ages of forty-to-sixty. After sixty, it is rare. The usual course of the disease is as follows:

It starts with an ache in the shoulder when the arm is moved. There is pain when the arm is kept still. After one month the pain is more severe and spreads down to the elbow. It is worse at night and increases further if the patient lies on the same side. Restriction of movement starts becoming obvious. After 2-3 months severe pain occurs at the slightest movement. The patient cannot raise his hand more than thirty to forty degrees. The rotative movement of the arm is also limited. After 4 months no further diminution takes place in the movement. The pain is at its worst at the end of 4 months. After 5 months it begins to reduce gradually. After 6 months there is no constant pain. Pain is felt only when the arm is moved. The patient is now able to lie on the painful side. After 7 months there is pain only in the upper part of the shoulder. After 8 months the range of movement begins to become wider. After one year the patient is almost well.

It has been noted that the pain and restriction of movement decrease during the first four months. During the next four months the pain decreases but the limitation of movement persists. In the last 4 months the range of movement returns. If exercises are done, the full range of movement is sure to return, and if no exercises are done, some amount of permanent limitation will persist at the shoulder joint.

In the severe variety, pain may go on increasing upto nine months. Wasting and thinning of muscles also start and complete recovery may take upto two years.

Treatment
Some doctors advise forced mobilization under general anesthesia. Though some very good results have been achieved by this process, some grave setbacks also occur. This treatment is therefore not advisable because during this act a tear in the lower part of the capsule can occur. This has been seen by orthography taken before and after the treatment. We believe that skill and experience play a dominant role in achieving good results. It is very important to know when to stop and how to grade these maneuvers. This is practically impossible when the manipulation is done under anesthesia, because the results are only known the next day or when the patient wakes up. For such cases we recommend a gradual stretching of the shoulder without anesthesia. However this is not as simple as it sounds. If there is too much stretching, it provokes pain and if there is too little, it does not produce any results. Stretching has to be done with great care. The patient feels great discomfort when the arm reaches the restricted range; it should then be coaxed a little further without increasing the pain or producing a muscle spasm. The shoulder should be moved in this final increased range for five to seven minutes twice a week. The patient should also be taught certain exercises which should be done twice a day at home. This treatment, in my experience, reduces the recovery period to two to three months. Sometimes cervical and upper dorsal manipulation along with mobilization is helpful.
This treatment can also be given in the case of a frozen shoulder after an accident.
There are other cases where the patient feels pain in the shoulder joint, but it is radiated from the neck. In these cases, 'the shoulder is nothing, the neck is everything!' Here manipulation of the lower cervical spine brings about a spectacular recovery, and when this is so, the above diagnosis is confirmed. In these cases movement at the shoulder joint is quite free. Pain may radiate in the whole arm from the base to the neck, accompanied by numbness, a tingling sensation and a feeling of pins and needles in the hands.
The pain in the shoulder may also be caused by diseases of the thorax and abdomen.

Exercises
Keeping the joint mobile is very important. This can be done at home in the following way:
1. Stand up, bend forward, leave your arm hanging loose, take it to the right as far as you can, then to the left. Then take it forward and backward. Rotate the arm clockwise and anti-clockwise. Repeat this twenty times. (Fig. 40, A & B).
2. Stand by the side of the wall, with your affected shoulder on the wall side. Now bend your arm at the elbow. Rest the forearm on a platform by the wall as high as possible. Bend your knees and slowly come down. As you come down you will stretch your shoulder up. Go down as far as you can and then come up. Repeat this twenty times (Fig. 40, C).

Case Histories

@ A fifty-five-year old man had pain in his right shoulder and his movement was restricted for five months. He had no history of injury. The pain in the right shoulder went on increasing. Along with doing exercises, he took diathermy and intra-articular hydro-cortisone injections, but nothing helped.
He came to me with this complaint. The X-ray of his shoulder joint was clear: the cervical spine showed spondylosis. The blood sugar was high. He could not raise his arm more than forty-five degrees.
Manipulative treatment was started and he was called twice a week. He was taught a few exercises to be done at home. By the end of three weeks, he could raise his arm to about 1200. Treatment continued for two months and he was ninety per cent better. He was advised to continue exercises and come fortnightly for treatment. Two months later he was completely free of pain.

@ A thirty-eight-year old man, thinly built, had a severe pain in the left shoulder radiating to the arm, with a tingling sensation in the left hand. He had had a similar attack a year before which had cleared in two months. He took anti-inflammatory drugs which gave him little relief He consulted orthopaedic surgeons and an X-ray was taken, confirming that he had spondylosis of the cervical spine.
Manipulative treatment was started. Following the treatment he had no pain for four days. He was cured after the third round of manipulative treatment.

Cervical Mobilization in Post Traumatic Headache/Cervicalgia

Source: www.birf.info/home/library/ alt-med/altmedlib_cervmob.html

By Sherman Gorbis, DO, FAAO

All osteopathic physicians, in their first two years of osteopathic medical college training, are taught Osteopathic Palpatory Diagnosis and Osteopathic Manipulative Treatment (OMT). OMT is one type of manual medicine. OMT is defined as “The therapeutic application of manually guided forces by an osteopathic physician to improve physiologic function and/or support homeostasis that have been altered by somatic dysfunction” (1). Somatic dysfunction is defined as “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.” Somatic dysfunction is treated using OMT (1).

The diagnostic triad for diagnosing somatic dysfunction is ART:
Asymmetry-determined visually and by palpation
Restriction of motion-determined by palpation
Tissue texture abnormality-determined by palpation

Traumatic cervicalgia (neck pain) can occur as a result of a motor vehicle accident (commonly during/after a whiplash injury where the head and neck are thrown forward/backward), sports related injury, or a fall (such as from a ladder, horse, etc).

It would be very common and not un-expected for the patient who has experienced trauma to have Post Traumatic Headache/Cervicalgia (neck pain) with accompanying somatic dysfunction in her/his cervical spine (bones that make up the neck). The cervical spine is divided into two regions based on their motion characteristics:

Atypical cervical vertebrae. This includes C0-C2 (the upper surface of C2). C0 is the occipital bone, which is located in the lower back area of the skull. The occiput articulates (joined together to allow motion between them) with the first cervical vertebra, C1. C1 articulates with the second cervical vertebra, C2. Several muscles that have attachments in the cervical spine, or below, also attach to the occiput. When these muscles become hypertonic (a sustained contraction but not a spasm (as with a ‘charley horse'), headache can occur. If restriction of motion is present between vertebrae, due to a disruption in the motion of the facets (small joints between the vertebrae which have pain generators) neck pain and headache can occur.
The headache may also result from irritation of the right and/or left greater occipital nerve. This travels through the articulation between the occiput and the first cervical vertebra. It then travels up behind the ear and forward along the temple.

Typical cervical vertebrae.
This includes C2-T1 (the lower surface of C2-the upper surface of T1). As above, both muscle hypertonicity and motion restriction can lead to headache and neck pain
Once a physician evaluates the patient who has been involved in trauma and he/she has determined that no contraindications (special conditions that render the use of the procedure inadvisable, usually due to risk) exist for manual medicine, the manual medicine provider then has several options.

Various types of OMT include:
Soft tissue. This refers is directed toward tissues other than bone or joints (1).

Muscle energy. The patient voluntarily moves the body as specifically directed by the operator; this is from a precisely controlled position against a defined resistance by the operator (1). Muscle energy is, for the most part, directed at loosening tight muscles using isometric (the muscle does not shorten during the contraction) contractions of the affected muscles. It is also directed at providing proper motion of the facet joints between the vertebrae. Facet joints are located both on the inferior and superior surfaces of vertebrae to allow one vertebra to move freely in relation to the vertebra below. Muscle energy techniques can treat facets that are either dysfunctionally ‘opened' or ‘closed'.

Direct Action Thrust (Mobilization with Impulse). Uses a high-velocity/low-amplitude activation, or thrust, to move a joint that is experiencing somatic dysfunction to help restore appropriate physiologic motion (1). This can be, sometimes, accompanied by an audible ‘click' or ‘pop'. However, the goal of treatment is the restoration of motion, not the presence of the sound.
Myofascial Release. This approach engages continual palpatory (the provider's hands in contact with the patient) feedback to achieve release of myofascial (muscles and their soft tissue/fascial coverings) tissues. This can be employed when tissue hypertonicity is present without severe motion restriction.

Other types of OMT include functional indirect and cranio-sacral.

Many insurance companies cover OMT and many osteopathic physicians who include OMT in their practices accept these plans. It is always helpful for the patient to inquire with his/her insurance company, as well as the provider, regarding coverage.

Resources
Ward RC, exec. ed. Foundations for Osteopathic Medicine 2 nd ed. Philadelphia : Lippincott Williams & Wilkins, 2003.American Academy of Osteopathy (AAO) This group's mission is to teach, advocate, advance, explore, and research the science and art of osteopathic medicine, emphasizing osteopathic principles, philosophy, palpatory diagnosis and OMT in total health care. Most, if not all, members use OMT in some degree in their practices. Phone (317) 879-1881 Fax (317) 879-0563 www.academyofosteopathy.orgAmerican Osteopathic Association (AOA) Patients can inquire about educational materials regarding OMT. www.aoa-net.org
Sherman Gorbis, DO, FAAO is a graduate of the Kansas City (MO) College of Osteopathic Medicine . He interned at Riverside Osteopathic Hospital ( Trenton , MI ). He earned his certification in Osteopathic Manipulative Medicine (OMM) in 1991 and his Fellowship in the American Academy of Osteopathy (FAAO) in 1995. He is presently an Associate Professor in the Department of OMM at Michigan State University College of Osteopathic Medicine ( East Lansing , MI ).

Treating a Whiplash with Osteopathic Manipulative Treatment(OMT)

Source: orthoinfo.aaos.org/fact/ thr_report.cfm?Thread_ID=232&topcategory=Neck

Imagine yourself driving when a car behind you rear-ends your vehicle. The impact pushes your car forward. It takes about 100 milliseconds for your body to catch up to the forward movement. Your shoulders travel forward until they are under your head, and your neck extends forward as your head tilts slightly down toward your steering wheel. You step on the brakes, bringing the car to an abrupt halt. The sudden stop throws your head and neck backward, and they bounce against the headrest. In a matter of seconds, you've experienced the classic mechanism of injury for whiplash.

About 20 percent of people involved in rear-end collisions later experience symptoms that center in the neck region. Although most of these people recover quickly, a small number develop chronic conditions that result in severe pain and sometimes disability.

Signs and symptoms

People who experience whiplash may develop one or more of the following symptoms, usually within the first two days after the accident:

Neck pain and stiffness
Headaches
Pain in the shoulder or between the shoulder blades
Low back pain
Pain or numbness in the arm and/or hand
Dizziness
Ringing in the ears or blurred vision
Difficulty concentrating or remembering
Irritability, sleep disturbances, fatigue

Diagnosis and Treatment

How whiplash injuries occur is clearly understood, but the extent and type of injuries varies greatly. The diagnosis of whiplash is often one of exclusion. Most injuries are to soft tissues such as the disks, muscles and ligaments, and cannot be seen on standard X-rays. Your doctor may need to request specialized tests, such as computed tomography scans or magnetic resonance imaging (MRI).

In the past, whiplash injuries were often treated with immobilization in a cervical collar. However, the current trend is to encourage early movement, rather than immobilization. The soft collar may be used for a short term and on an intermittent basis.

Ice may be applied for the first 24 hours, followed by gentle active movement. Your doctor may provide you with a series of exercises that you can do at home. An early return to work is encouraged, even if your doctor must prescribe some temporary modifications in your work situation. No single treatment has been scientifically proven as effective, but pain relieving medications, exercises, physical therapy, traction, massage, heat, ice, injections and ultrasound have all been beneficial for some patients.

As soon as possible, you should begin aerobic activities, such as walking. Your doctor may prescribe some isometric exercises as your condition improves. Symptoms resolve within several months for about 75 percent of people who have whiplash. Chronic conditions should be investigated further and might require surgery.

Where OMT comes in handy.....

OMTs can be applied to a variety of health problems, both musculoskeletal and non-musculoskeletal. According to the US Department of Health and Human Services, OMTs are most effective for back and neck pain. In fact, if you have back pain, you may be able to reduce the amount of pain medication you are taking if you receive OMT as part of your therapy. One study showed that patients with pancreatitis were able to go home from the hospital sooner when they had OMT.

In one small study, people with Parkinson's disease were able to walk better after only one session of OMT. Another study looked at 38 patients who had knee surgery. Those who had OMT were able to walk up stairs 20% earlier than those who did not have OMT.

A study of 100 people with high blood pressure treated only with OMT showed that OMT produced significant reductions in blood pressure.
Studies show that OMT eases breathing, drains the sinuses and relieves the symptoms, duration, and recurrence of the common cold.
Osteopathy may also be an effective way to treat carpal tunnel syndrome. More studies are needed to confirm this.

Examples of other conditions for which OMT may be helpful include:

stress-related problems (such as tension headaches, muscle spasm)
strains and sprains (especially of the neck and back)
shoulder pain
osteoarthritis
headaches
painful menstruation
injuries (such as whiplash)
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Osteopathic study: Treatment cuts pain

Source: PCOM News Release

The Philadelphia College of Osteopathic Medicine has produced what it is calling the first study that provides "objective data" demonstrating how osteopathic manipulative treatment, or OMT, can reduce pain after surgery.

OMT focuses on learning the body's interconnected system of nerves, muscles and nerves, and understanding how an injury or illness to one part of the body can affect another. Doctors in osteopathic medical schools are taught how to use their hands to diagnose injuries and illness, and how to manipulate the musculoskeletal system to encourage the body's natural tendency to heal itself.

The PCOM study, led by Dr. Frederick Goldstein, involved 33 hysterectomy patients at City Avenue Hospital who were all unfamiliar with OMT.

Researchers measured the amount of morphine that was required to treat pain, and the patients' perception of the pain levels, following the surgical procedure.

The study contained two variables. Some patients received morphine prior to surgery and others received a saline solution. After surgery, certain patients from each group received OMT while the others got "sham OMT," where a doctor placed his or her hands on specific areas of the patients, but did not perform any manipulation.

The preliminary results of the study showed OMT had a greater effect than drugs in reducing post-operative pain, and that the osteopathic treatment worked to reduce pain regardless of whether the patients received morphine or saline prior to surgery.

"This study is breakthrough scientific proof that OMT has a crucial role in treating patients who are in pain," Goldstein said.

Goldstein and his team plan to release additional study results within the next six months.