Osteopathic Manipulative Medicine
Encyclopedia
Osteopathic Manipulative Medicine (OMM) is the application of the distinct osteopathic philosophy, structural diagnosis and use of Osteopathic Manipulative Technique (OMT) in the diagnosis and management of the patient. OMM takes into account the physical and mental health of a patient, and how either aspect could be contributing to the disease state. A Doctor of Osteopathic Medicine
(D.O.) is trained to perform a structural diagnosis integrated into the entire history and physical taking process, and to use OMT techniques when appropriate.
, M.D., D.O. was a 19th century American doctor who developed and promoted osteopathic medicine. A physician and Civil War surgeon, Still became disenchanted with contemporary medical practice after he lost three of his children to spinal meningitis. This loss motivated him to attempt to improve medicine.
Still used his understanding of anatomy to first screen for structural abnormalities (somatic dysfunction
) and then restore normal functionality as an essential part of treatment. He also emphasized the connection between mental, physical, emotional and spiritual health and taught that each plays an important role in overall patient health. As a result of his studies, a distinct approach to healthcare was created.
A. T. Still defined osteopathy as "that science which consists of such exact, exhaustive, and verifiable knowledge of the structure and function of the human mechanism, anatomical, physiological and psychological, including the chemistry and physics of its known elements, as has made discoverable certain organic laws and remedial resources, within the body itself, by which nature under the scientific treatment peculiar to osteopathic practice, apart from all ordinary methods of extraneous, artificial, or medicinal stimulation, and in harmonious accord with its own mechanical principles, molecular activities, and metabolic processes, may recover from displacements, disorganizations, derangements, and consequent disease, and regained its normal equilibrium of form and function in health and strength."
These principles are not held by osteopathic physicians to be empirical law
s; they serve, rather, as the underpinnings of the osteopathic philosophy on health and disease.
, rehabilitation, surgery, patient education, diet and exercise with each playing an important role in treating patients osteopathically. OMT techniques are not necessarily unique to osteopathic medicine. Other disciplines, such as physical therapy or chiropractics, use similar techniques.
OMT is commonly used to treat musculoskeletal problems like lower back pain and thoracic outlet syndrome
, but it may also be used as an adjunct therapy for other disorders like migraine
and pneumonia
.
of the patient's muscle. Once the patient relaxes, their range of motion increases slightly. The alternating contraction and relaxation helps the treated muscle increase its range of motion.
, which is inhibited by applying a position of mild strain in the direction exactly opposite to that of the reflex; this is accomplished by specific directed positioning about the point of tenderness to achieve the desired therapeutic response.
used to treat somatic dysfunction
and resulting pain and restriction of motion. It uses continual palpatory feedback to achieve release of
myofascial tissues. This is accomplished by relaxing contracted muscles, increasing circulation and lymphatic
drainage, and stimulating the stretch reflex
of muscles and overlying fascia
.
Fascia
is the soft tissue
component of the connective tissue
that provides support and protection for most structures within the human body, including muscle
. This soft tissue can become restricted due to psychogenic disease
, overuse, trauma, infectious agents, or inactivity, often resulting in pain, muscle tension, and corresponding diminished blood flow
. Although fascia and its corresponding muscle are the main targets of myofascial release, other tissue may be affected as well, including other connective tissue.
Doctor of Osteopathic Medicine
Doctor of Osteopathic Medicine is a professional doctoral degree for physicians in the United States. Holders of the MD degree, Doctor of Medicine, have the same rights, privileges and responsibilities as osteopathic physicians in the United States.The American Osteopathic Association’s Commission...
(D.O.) is trained to perform a structural diagnosis integrated into the entire history and physical taking process, and to use OMT techniques when appropriate.
Origins
Andrew Taylor StillAndrew Taylor Still
Andrew Taylor Still is considered the father of osteopathy and osteopathic medicine. He was also a physician & surgeon, author, inventor and Kansas territorial & state legislator. He was one of the founders of Baker University, the oldest 4-year college in the state of Kansas, and was the founder...
, M.D., D.O. was a 19th century American doctor who developed and promoted osteopathic medicine. A physician and Civil War surgeon, Still became disenchanted with contemporary medical practice after he lost three of his children to spinal meningitis. This loss motivated him to attempt to improve medicine.
Still used his understanding of anatomy to first screen for structural abnormalities (somatic dysfunction
Somatic dysfunction
In osteopathic medicine and osteopathy, somatic dysfunction is the impaired or altered function of bodily structures treated by osteopathic manual technique .-Diagnosis:...
) and then restore normal functionality as an essential part of treatment. He also emphasized the connection between mental, physical, emotional and spiritual health and taught that each plays an important role in overall patient health. As a result of his studies, a distinct approach to healthcare was created.
A. T. Still defined osteopathy as "that science which consists of such exact, exhaustive, and verifiable knowledge of the structure and function of the human mechanism, anatomical, physiological and psychological, including the chemistry and physics of its known elements, as has made discoverable certain organic laws and remedial resources, within the body itself, by which nature under the scientific treatment peculiar to osteopathic practice, apart from all ordinary methods of extraneous, artificial, or medicinal stimulation, and in harmonious accord with its own mechanical principles, molecular activities, and metabolic processes, may recover from displacements, disorganizations, derangements, and consequent disease, and regained its normal equilibrium of form and function in health and strength."
Principles
The osteopathic medical philosophy is defined as the concept of health care that embraces the concept of the unity of the living organism’s structure (anatomy) and function (physiology). These are the four major principles of osteopathy:- The body is an integrated unit of mind, body, and spirit
- The body possesses self-regulatory mechanismsHomeostasisHomeostasis is the property of a system that regulates its internal environment and tends to maintain a stable, constant condition of properties like temperature or pH...
, having the inherent capacity to defend, repair, and remodel itself. - Structure and function are reciprocally inter-related.
- Rational therapy is based on consideration of the first three principles.
These principles are not held by osteopathic physicians to be empirical law
Scientific law
A scientific law is a statement that explains what something does in science just like Newton's law of universal gravitation. A scientific law must always apply under the same conditions, and implies a causal relationship between its elements. The law must be confirmed and broadly agreed upon...
s; they serve, rather, as the underpinnings of the osteopathic philosophy on health and disease.
Diagnosing disease
There are five main components to osteopathic care. Since each plays an important role in the overall health of a patient, each should be considered when diagnosing and treating a patient. The five components are:- Biomechanical
- Neurological
- Respiratory/Circulatory
- Metabolic
- Behavioral
Treatment
OMT is only one component of Osteopathic Medicine. It may be used alone or in combination with pharmacotherapyPharmacotherapy
Pharmacotherapy is the treatment of disease through the administration of drugs. As such, it is considered part of the larger category of therapy....
, rehabilitation, surgery, patient education, diet and exercise with each playing an important role in treating patients osteopathically. OMT techniques are not necessarily unique to osteopathic medicine. Other disciplines, such as physical therapy or chiropractics, use similar techniques.
OMT is commonly used to treat musculoskeletal problems like lower back pain and thoracic outlet syndrome
Thoracic outlet syndrome
Thoracic outlet syndrome is a syndrome involving compression at the superior thoracic outlet involving compression of a neurovascular bundle passing between the anterior scalene and middle scalene...
, but it may also be used as an adjunct therapy for other disorders like migraine
Migraine
Migraine is a chronic neurological disorder characterized by moderate to severe headaches, and nausea...
and pneumonia
Pneumonia
Pneumonia is an inflammatory condition of the lung—especially affecting the microscopic air sacs —associated with fever, chest symptoms, and a lack of air space on a chest X-ray. Pneumonia is typically caused by an infection but there are a number of other causes...
.
Muscle Energy
Muscle energy techniques address somatic dysfunction through stretching and muscle contraction. For example, if a person is unable to fully abduct their arm, the treating physician raises the person's arm to the edge of the restrictive barrier. The patient then tries to lower their arm, while the physician provides resistance. This resistance against the patient's motion allows for isometric contractionMuscle contraction
Muscle fiber generates tension through the action of actin and myosin cross-bridge cycling. While under tension, the muscle may lengthen, shorten, or remain the same...
of the patient's muscle. Once the patient relaxes, their range of motion increases slightly. The alternating contraction and relaxation helps the treated muscle increase its range of motion.
Counterstrain
Counterstrain is a system of diagnosis and treatment that considers the dysfunction to be a continuing, inappropriate strain reflexReflex
A reflex action, also known as a reflex, is an involuntary and nearly instantaneous movement in response to a stimulus. A true reflex is a behavior which is mediated via the reflex arc; this does not apply to casual uses of the term 'reflex'.-See also:...
, which is inhibited by applying a position of mild strain in the direction exactly opposite to that of the reflex; this is accomplished by specific directed positioning about the point of tenderness to achieve the desired therapeutic response.
Myofascial release
Myofascial release is a form of soft tissue therapySoft tissue therapy
Soft tissue therapy is the assessment, treatment and management of soft tissue injury, pain and dysfunction primarily of the neuromusculoskeletal system....
used to treat somatic dysfunction
Somatic dysfunction
In osteopathic medicine and osteopathy, somatic dysfunction is the impaired or altered function of bodily structures treated by osteopathic manual technique .-Diagnosis:...
and resulting pain and restriction of motion. It uses continual palpatory feedback to achieve release of
myofascial tissues. This is accomplished by relaxing contracted muscles, increasing circulation and lymphatic
Lymph
Lymph is considered a part of the interstitial fluid, the fluid which lies in the interstices of all body tissues. Interstitial fluid becomes lymph when it enters a lymph capillary...
drainage, and stimulating the stretch reflex
Stretch reflex
The stretch reflex is a muscle contraction in response to stretching within the muscle. It is a monosynaptic reflex which provides automatic regulation of skeletal muscle length....
of muscles and overlying fascia
Fascia
A fascia is a layer of fibrous tissue that permeates the human body. A fascia is a connective tissue that surrounds muscles, groups of muscles, blood vessels, and nerves, binding those structures together in much the same manner as plastic wrap can be used to hold the contents of sandwiches...
.
Fascia
Fascia
A fascia is a layer of fibrous tissue that permeates the human body. A fascia is a connective tissue that surrounds muscles, groups of muscles, blood vessels, and nerves, binding those structures together in much the same manner as plastic wrap can be used to hold the contents of sandwiches...
is the soft tissue
Soft tissue
In anatomy, the term soft tissue refers to tissues that connect, support, or surround other structures and organs of the body, not being bone. Soft tissue includes tendons, ligaments, fascia, skin, fibrous tissues, fat, and synovial membranes , and muscles, nerves and blood vessels .It is sometimes...
component of the connective tissue
Connective tissue
"Connective tissue" is a fibrous tissue. It is one of the four traditional classes of tissues . Connective Tissue is found throughout the body.In fact the whole framework of the skeleton and the different specialized connective tissues from the crown of the head to the toes determine the form of...
that provides support and protection for most structures within the human body, including muscle
Muscle
Muscle is a contractile tissue of animals and is derived from the mesodermal layer of embryonic germ cells. Muscle cells contain contractile filaments that move past each other and change the size of the cell. They are classified as skeletal, cardiac, or smooth muscles. Their function is to...
. This soft tissue can become restricted due to psychogenic disease
Psychogenic disease
A psychogenic disease is a set of symptoms or complaints whose origin likely lies within the complex interactions of the frontal lobes of the brain and the system in which the complaint manifests...
, overuse, trauma, infectious agents, or inactivity, often resulting in pain, muscle tension, and corresponding diminished blood flow
Ischemia
In medicine, ischemia is a restriction in blood supply, generally due to factors in the blood vessels, with resultant damage or dysfunction of tissue. It may also be spelled ischaemia or ischæmia...
. Although fascia and its corresponding muscle are the main targets of myofascial release, other tissue may be affected as well, including other connective tissue.
Further reading
- Ward, Robert C. et al.; Foundations for Osteopathic Medicine (2nd ed.). Philadelphia: Lippincot Williams and Wilkins. ISBN 0-7817-3497-5.
- American Association of Colleges of Osteopathic Medicine (2009); Glossary of Osteopathic Terminology.