Foundations for Osteopathic Medicine

FOUNDATIONS FOR OSTEOPATHIC MEDICINE, 2ND EDITION......Page 1
Copyright
......Page 4
Dedication
......Page 5
Contents
......Page 8
Contributors
......Page 12
Mission Statement
......Page 16
Preface
......Page 18
Preface to the First Edition
......Page 20
Forward
......Page 22
Ackowledgments
......Page 24
SECTION I: OSTEOPATHIC PHILOSOPHY AND HISTORY
......Page 26
How It All Began
......Page 28
Origins of Osteopathic Philosophy
......Page 29
Normal Nerve Activity and Flow of Body Fluids
......Page 30
The Body Provides Its Own Drug Store
......Page 31
Individualized Treatment
......Page 32
Evolution of Osteopathic Philosophy
......Page 33
The Definition of Osteopathy
......Page 34
The Educational Council on Osteopathic Principles
......Page 35
Osteopathic Principles As Practice Guidelines
......Page 36
An Explication of Osteopathic Principles- by Irvin M. Korr
......Page 37
The Person as a Whole
......Page 38
The Place of the Musculoskeletal System in Human Life
......Page 39
The Three Principles As Guides to Medical Practice
......Page 40
Our Personal Health Care Systems
......Page 41
2. MAJOR EVENTS IN OSTEOPATHIC HISTORY
......Page 44
First School
......Page 46
Curriculum
......Page 47
Research
......Page 48
State Licensure
......Page 49
Osteopathic Organization
......Page 50
Specialties
......Page 51
Conclusion
......Page 52
SECTION II: OSTEOPATHIC CONSIDERATIONS IN BASIC SCIENCES
......Page 56
Anatomy
......Page 57
Respiration/Circulation
......Page 58
Conclusion
......Page 59
Rule 1: Rule of Proximity 
......Page 62
Rule 2: Rule of Function
......Page 63
Rule 3: Rule of Supply
......Page 64
Rule 4: Rule of Drainage 
......Page 65
Rule 6: Rule of Connectedness
......Page 66
Conclusion
......Page 68
Neuromusculoskeletal Embryology
......Page 69
Connective Tissue
......Page 71
Cartilage and Bone
......Page 72
Synovial and Nonsynovial Joints
......Page 74
Joint Play
......Page 76
Fascia and Neurovascular Bundle
......Page 77
Muscle Action
......Page 79
Segmental Organization of the Neuromusculoskeletal and Vascular Systems
......Page 80
Myofascial Continuity
......Page 83
Dedication
......Page 85
Biomechanicals Describes the Relationship Between Structure and Function
......Page 88
Motion and Forces Can Be Described as Components With a Magnitude in Each Dimension of Three-Dimensional Space
......Page 89
The Elastic Modulus Shows the Relationship Between Stress and Strain
......Page 91
Viscoelasticity is the Combination of Elastic and Viscous Properties of Materials in Response to Stress
......Page 92
Bone is an Anisotropic Material Comprised of Osteons
......Page 93
Different Stress Vectors Produce Varying Types of Bone Failure (Fracture)
......Page 94
Cartilage Has Significant Viscoelastic Properties That are Essential to Its Function
......Page 95
Ligaments and Tendons are Dense, Regular Connective Tissue with a High Resistance to Tensile Loading
......Page 96
Ligaments and Tendons Can Adapt to Stresses......Page 97
Types of Muscle Contraction Are Defined by the Movements Occuring During Contraction......Page 98
A Rise in Temperature Can Increase the Efficiency of Muscle Contraction......Page 99
Force Movement Are Used to Describe Models of Musculoskeletal Movement......Page 100
Muscle Moments Are Also Transferred Across Joints by Tendons......Page 101
Joint Surfaces Have Several Different Types of Relative Movement......Page 102
Primary Muscle Forces Through the Knee Are Conducted Through the Hamstrings and the Patellar Tendon......Page 103
Knee Joint Structure and the Movement of Joint Surfaces Promote Efficiency of Movement......Page 104
Models of Hip Function Balance Ground Reaction, Joint, and Muscle Contraction Forces......Page 105
The Elbow Comples Provides an Example of Dysfunctions from the Coupling of Intraarticular Motion......Page 106
Shoulder Range of Motion is Usually Described for the Entire Joint Complex Rather than Individual Joints......Page 107
Intervertebral Discs Are Structured to Cushion and Distribute Stresses between Vertebrae......Page 108
The Motion of the Spine is a Composite of Small Movements in Individual Vertebrae and Coupling Between Vertebrae......Page 109
Some Kinetic Considerations of Spinal Loading......Page 110
Normal Locomotion (Gait) Employs the Entire body for Efficiency of Movement......Page 111
Acknowledgments......Page 112
6. AUTONOMIC NERVOUS SYSTEM
......Page 115
Somatic Reflex Arc......Page 116
Autonomic Reflex Arc......Page 117
Divisions of the Autonomic Nervous System......Page 118
Sympathetic Autonomic Nervous System......Page 119
Parasympathetic Autonomic Nervous System......Page 121
Trunk and Limbs......Page 122
Head and Neck......Page 124
Thorax......Page 125
Abdominopelvic Region......Page 129
Conclusion......Page 141
7. NEUROPHYSIOLOGIC MECHANISMS OF INTEGRATION AND DISINTEGRATION
......Page 145
The Reflex......Page 146
Structure......Page 147
Reflex Interactions......Page 148
Neural Basis for Reflex Interactions......Page 149
Sympathetic Innervation of the Heart......Page 150
Parasympathetic Innervation of the Heart......Page 151
Visceral Function Control......Page 152
Summation Characteristics of Somato-Visceral Reflexes......Page 153
Alteration of Integrative Function......Page 154
Alteration of Nociceptive Stimuli......Page 155
Nonimpulse-Based Integration......Page 158
Conclusion......Page 159
Pathophysiology of Somatic Dysfunction......Page 162
Small Fiber System Provides Nociception and General Adaptation......Page 163
Peripheral Sensitization of Primary Afferent Nociceptors......Page 164
Mode One: Normal Input-Normal Output......Page 165
Mode Three: Normal Input-Enhanced Output......Page 167
Mode Four: Subnormal Input-Grossly Enhanced Output......Page 168
Ascending Spinal Pathways......Page 170
Brainstem Reticular Formation......Page 171
Arousal and the Neuroendocrine Immune Network......Page 172
The Cytokine Network......Page 174
Allostasis......Page 175
Allostatic Load......Page 176
Allostasis, the General Compensatory Response and Disease......Page 177
Reexamination of the Osteopathic Philosophy of Medicine......Page 178
9. TISSUE RESPIRATION AND CIRCULATION
......Page 182
Regulation of Tissue Respiration......Page 183
General Mechanisms Governing Local Regulation of Blood Flow......Page 184
Elements of Local Control of Blood Flow......Page 185
Regulation of Blood Flow in the Myocardium......Page 186
Regulation of Skin Blood Flow......Page 188
Summary......Page 189
Worldwide Importance......Page 190
National Importance......Page 191
Osteopathy and the Germ Theory of Disease......Page 192
Host Peculiarities and Disease......Page 193
Specific Examples of How Microorganisms Make Us Sick......Page 194
Barriers That Limit the Success of Microbes......Page 195
Inflammation and Other Nonspecific Defences......Page 196
Specific Immunologic Mechanisms......Page 197
The Importance of a Healthy Diet......Page 198
The Principles of Chemotherapy and Present-Day Worries......Page 199
The Importance of Hygiene......Page 200
Modern-Day Vaccines and Safety Issues......Page 201
Acknowledgments......Page 202
Chemical Structure of Hormones......Page 204
Cellular Processing......Page 206
Transport and Metabolism......Page 207
Lipophilic Hormones......Page 208
Amines......Page 209
Control Mechanisms......Page 210
Temporal Patterns......Page 211
Processes Regulated by Hormones......Page 212
Conclusion......Page 213
12. PHARMACOLOGIC AND OSTEOPATHIC BASIC PRINCIPLES
......Page 214
SECTION III: OSTEOPATHIC CONSIDERATIONS IN THE BEHAVIOURAL SCIENCES......Page 220
13. HEALTH PROMOTION AND MAINTENANCE
......Page 222
Nutrition......Page 223
Physical Activity......Page 224
Tobacco......Page 225
Alcohol......Page 226
Sexuality......Page 227
Stress......Page 228
Doctor-Patient Relationship......Page 229
Strategy 1: Informing the Patient......Page 230
Conclusion......Page 231
Research......Page 233
Implications for Medical Education......Page 234
Conclusion......Page 235
History of Pain Theory......Page 237
Gate-Control Theory......Page 238
Defining Pain......Page 239
Neuropathic Pain......Page 240
Spinothalamic Pathways......Page 241
Pain Perception......Page 242
Pain Management......Page 244
Analgesics......Page 245
Analgesic Adjuvants......Page 246
Counter Irritants......Page 247
Behaviour Modification......Page 248
Conclusion......Page 249
Prenatal Period......Page 252
Ages One to Five......Page 253
Adolescence......Page 254
Elderly......Page 255
Conclusion......Page 256
Stress As Process......Page 258
Theories of Stress......Page 259
Depression......Page 260
Measurement of Depression......Page 261
Anxiety......Page 262
Anxiety Treatments......Page 263
Alcohol as Cause of Further Stress......Page 264
Sense of Control......Page 265
Cognitive Restructuring......Page 266
Psychophysiologic Insomnia Management......Page 267
Conclusion......Page 268
History of Osteopathic Psychiatry......Page 270
Mental Health and Illness: "The Brain-Body Dilemma"......Page 271
Psychiatric Diagnoses, Data Collection, and Medical Recordkeeping......Page 272
General Anxiety Disorder......Page 273
Brief Psychotic Disorder......Page 274
Benzodiazepine Abuse......Page 275
Delirium......Page 276
Assessment of Axis II Personality Disorders......Page 277
Conclusion......Page 278
SECTION IV: OSTEOPATHIC CONSIDERATION IN CLINICAL PROBLEM SOLVING......Page 280
Discussion......Page 282
Abdominal Pain......Page 283
Caveats......Page 284
Hypothetico-Deductive Method......Page 285
Problem-oriented Perspective......Page 286
Clinical Decision Analysis......Page 288
Osteopathic Physicians' Clinical Problems Solving......Page 289
Case One......Page 290
Case Two......Page 291
Case Four......Page 292
Osteopathic Approach......Page 293
Case Seven......Page 294
Musculoskeletal Pain......Page 295
Patient As A Whole......Page 296
Description......Page 297
Cardiovascular......Page 298
Gastrointestinal Referred Pain......Page 299
Physical Examination......Page 300
Conclusion......Page 301
SECTION V: OSTEOPATHIC CONSIDERATION IN FAMILY PRACTICE AND PRIMARY CARE
......Page 306
Osteopathic Family Medicine and Primary Care......Page 314
Osteopathic Diagnosis and Treatment of Disease......Page 315
The Role of Palpatory Diagnosis and Manipulative Care......Page 316
Treating the Whole Person......Page 318
Longitudinal Care......Page 319
Psychosocial Considerations in Family Practice......Page 320
Conclusions......Page 321
Distinctiveness of Osteopathic Internal Medicine......Page 323
Managing Patients with Complex Problems......Page 324
Case One......Page 325
Case Two......Page 326
Use of Osteopathic Manipulative Therapy for Visceral Disorders by Osteopathic Internists......Page 327
Conclusion......Page 328
Osteopathic Pediatrics as Primary Care......Page 330
Osteopathic Pediatric History......Page 332
Musculoskeletal System......Page 333
Mechanics of Pediatric Respiratory System......Page 339
The Pediatric Gastrointestinal System......Page 345
Neurologic Dysfunction in Children......Page 346
Conclusion......Page 350
Theories of Aging......Page 352
Physiology of Aging......Page 354
Medical Assessment......Page 355
Functional Assessment......Page 356
Psychological Assessment......Page 357
Confusion......Page 358
Falling......Page 359
Iatrogenesis......Page 360
Conclusion......Page 361
SECTION VI: OSTEOPATHIC CONSIDERATIONS IN THE CLINICAL SPECIALTIES
......Page 364
Tenet I: A Person Is the Product of Dynamic Interaction between Body, Mind, and Spirit......Page 370
Tenet II: An Inherent Property of This Dynamic Interaction Is the Capacity of the Individual for the Maintenance of Health and Recovery from Disease......Page 372
Tenet III: Many Forces, Both Intrinsic and Extrinsic to the Person, Can Weaken This Inherent Capacity and Contribute to the Onset of Illness......Page 373
Tenet IV: The Musculoskeletal System Significantly Influences the Individual's Ability to Restore the Inherent Capacity to Maintain Health and Therefore to Resist Disease Process......Page 374
Vascular Biology of Acute Coronary Syndromes......Page 375
Diagnosis......Page 376
Therapy......Page 378
Challenges......Page 380
A Quartet of Clinical Vignettes......Page 382
Pathophysiology and Natural History......Page 383
Diagnosis......Page 385
The Muscle Hypothesis......Page 386
Osteopathic Implication......Page 387
25. OSTEOPATHIC MANAGEMENT OF EAR, NOSE, AND THROAT DISEASE
......Page 395
Lymphatic Circulation in the Head and Neck......Page 396
Autonomic Nervous Supply in the Head and Neck......Page 397
Healthy Structure and Function......Page 398
Common Pathophysiology......Page 399
Treatment/Management......Page 400
Healthy Structure and Function......Page 401
Common Pathophysiology......Page 402
Treatement/Management......Page 403
Diagnosis......Page 404
Musculoskeletal Approach to the Ear, Nose, and Throat Patient......Page 405
History and Development of Osteopathic Emergency Medicine as a Profession......Page 408
Logistics and Demographics within Emergency Medicine......Page 409
Theoretical Aspects of the Osteopathic Medicine Approach to the Patient in the Emergency Department......Page 411
The Screening Examination......Page 412
The Osteopathic Approach to the Patient with Complaints in the Head and Neck Region......Page 414
The Osteopathic Approach to the Patient with Chest Pain......Page 417
The Osteopathic Approach to Disorders of the Cardiopulmonary System......Page 419
Osteopathic Considerations in Patients with Abdominal/Pelvic Pain......Page 420
Summary......Page 422
27. GENERAL SURGERY
......Page 424
Osteopathic Evaluation and Treatment of the Patient with Acute Abdominal Pain......Page 425
Case Two......Page 427
Case Three......Page 428
Case Four......Page 429
Atelectasis......Page 430
Ileus......Page 431
Conclusion......Page 432
Anatomy......Page 434
Patient Evaluation: History and Physical Examination......Page 437
Prementrual Syndrome......Page 438
Ovarian Pain......Page 439
Pelvic Infammatory Disease......Page 440
Pelvic Floor Dysfunction......Page 441
Conclusion......Page 442
29. NEUROMUSCULOSKELETAL MEDICINE AND OSTEOPATHIC MANIPULATIVE MEDICINE
......Page 445
The Role of the Osteopathic Manipulative Medicine Specialist......Page 446
Physical Examination......Page 447
General Considerations......Page 451
Special Considerations......Page 453
The Osteopathic Consultation......Page 454
Case Presentation......Page 456
Diagnostics......Page 457
Initial OMT......Page 458
Acknowledgments......Page 459
Overview......Page 460
Concept of Somatic Dysfunction......Page 461
Headaches......Page 462
Migraine Headaches......Page 463
Cluster Headaches......Page 464
Treatment......Page 466
Spinal Disorders......Page 467
Entrapment Neuropathies......Page 469
Carpal Tunnel Syndrome......Page 470
Conclusion......Page 472
Low Back Pain......Page 475
Changes in Body Fluids and Circulation......Page 477
First Trimester......Page 478
Second Trimester......Page 479
Third Trimester......Page 480
Labor and Delivery......Page 482
Conclusion......Page 484
Oncology......Page 487
Touching as Communication......Page 488
Lung Carcinoma......Page 489
Musculoskeletal System......Page 490
Central Nervous System......Page 492
Peripheral Nervous System......Page 493
A Possible Viscersomatic-Type Oncologic Response......Page 494
Ethics of Presentation of Diagnostic and Treatment Options to the Patient......Page 495
Blood and Blood Products......Page 496
Stress of Disease and Treatment of the Patient as Modulators of Biologic Response......Page 497
Contraindications for Osteopathic Manipulative Treatment......Page 498
Conclusion......Page 499
33. ORTHOPEDICS
......Page 502
Developmental Dysplasia of the Hip......Page 504
Hip Fracture in the Geriatric Population......Page 507
Osteoarthritis of the Knee......Page 508
Low Back Pain......Page 510
History and Physical Examination......Page 511
Pathophysiology......Page 513
Differential Diagnosis......Page 515
Management......Page 516
Instability of the Shoulder......Page 519
Osteopathic Approaches to Ligamentous Laxity......Page 521
Conclusion......Page 523
34. PULMONOLOGY
......Page 525
Ventilation......Page 526
Pulmonary Circulation......Page 528
Pulmonary Gas Exchange......Page 529
Ventilatory Control......Page 530
The Osteopathic Approach......Page 531
Thoracic Lymphatic Drainage......Page 532
Osteopathic Manipulative Treatment......Page 533
Pulmonary Function......Page 534
Thoracic Pump......Page 535
Respiratory Infection......Page 536
Chronic Obstructive Pulmonary Disease......Page 537
Prevention of Postoperative Pulmonary Complications......Page 538
Conclusion......Page 539
Definition of the Specialty of Physical Medicine and Rehabilitation......Page 541
History of Physical Medicine and Rehabilitation......Page 542
Patient Evaluation by the Osteopathic Physiatrist......Page 543
The Use of Manipulation in Physiatric Practice......Page 544
Research Regarding Manipulation in Physiatric Practice......Page 545
Low Back Pain......Page 547
Carpal Tunnel Syndrome......Page 548
Manipulation in Sports Rehabilitation Medicine......Page 549
Acknowledgments......Page 550
Patient Evaluation and Problem-Solving......Page 551
Palpation......Page 552
Rheumatoid Arthritis......Page 553
Osteoarthritis......Page 554
Nonpharmacologic Treatments......Page 555
Surgery......Page 556
Acknowledgments......Page 557
Why is There Such An "Exercise Boom?"......Page 559
Pre-Participation Physical......Page 560
History......Page 561
Palpatory Examination......Page 562
The Functional Biomechanical Examination......Page 563
Back Pain and Spondyloysis......Page 564
Functional Approach......Page 569
The Success Imperative......Page 570
Concussions, Headaches, and Neurologic Deficits in Athletes......Page 571
The Use of Performance-Enhancing (Ergogenic) Drugs......Page 573
Sideline and Event Medical Management Issues......Page 574
Conclusions......Page 575
SECTION VII: OSTEOPATHIC CONSIDERATIONS IN PALPATORY DIAGNOSIS AND MANIPULATIVE TREATMENT......Page 576
Art of Palpation......Page 582
Exercise 3: The Dominant Eye......Page 583
Exercise 4: Layer Palpation......Page 584
Exercise 5: Palpate Your Partner's Forearm......Page 585
Exercise 7: Palpating Spinal Motion and Paravertebral Tissues......Page 586
Acute Somatic Dysfunction......Page 587
Thoracic Region......Page 588
Sacroiliac Region......Page 589
Acknowledgments......Page 590
The Osteopathic Examination......Page 591
Structures Predisposing to Somatic Dysfunction......Page 592
Somatic Dysfunction and Structure......Page 593
Origin of Coupled Motions: Type I, Type II, and Simple-Compound Concepts......Page 594
Physiologic Mechanisms and Somatic Dysfunction......Page 596
Conclusion
......Page 597
Diagnosis
......Page 599
Approach
......Page 600
Sequence
......Page 601
Direct or Indirect Method
......Page 602
Conclusion
......Page 603
Optimal Posture......Page 605
Postural Decompensation......Page 606
Clinical Significance of Fascial Patterns......Page 608
Treatment......Page 610
Manipulative Treatment of Group Curves......Page 611
Epigastric Thrust......Page 612
Postural Exercise......Page 613
Conclusion......Page 614
Materials......Page 616
Procedure......Page 617
Anteroposterior Postural Radiographs......Page 618
General Considerations......Page 619
Results......Page 620
Interpreting Anteroposterior Postural Radiographs of the Pelvis......Page 621
Interpreting Lateral Postural Radiographs of the Pelvis......Page 622
Exercise One: Anteroposterior Postural X-Ray View of Pelvis......Page 624
Exercise Two: Lateral Postural X-Ray View of the Lumbopelvic Region......Page 625
Conclusion......Page 626
Gravitational Strain and Postural Decompensation......Page 628
Postural Homeostasis and Strain......Page 629
Somatic Structures Stressed: Muscles......Page 630
Somatic Structures Stressed: Skeletal-Arthrodial......Page 631
Postural Diagnosis......Page 632
Observation and Palpation......Page 633
Radiographic Findings......Page 634
Exercise......Page 637
Orthotics, Braces, and Other Adjunctive Treatment......Page 638
Diagnosis......Page 639
Lift Therapy......Page 640
Diagnosis......Page 643
Radiographic Measurement......Page 645
Sagittal Plane Disorders......Page 647
Diagnosis......Page 650
Treatment......Page 653
Conclusion......Page 655
Indentification of Somatic Dysfunction......Page 658
A Musculoskeletal Examination......Page 659
Specific Tests for the Musculoskeletal Examination......Page 660
Posterior Screen of Horizontal Planes......Page 663
Upper Extremity Screen for Joint Dysfunction: Extend Arms over Head, Active (or Passive)......Page 664
Standing Gross Spinal Flexion Test......Page 665
Optimal Patient Position for Segmental Musculoskeletal Examination of Body Regions......Page 671
Somatic Dysfunction in Ambulatory or Bedridden Patients......Page 674
Example: Screening Examination of the Musculoskeletal System of the Ambulatory Clinic or Ambulatory Hospitalized Patient......Page 677
Example: Screening Musculoskeletal Examination of a Bedridden Clinic or Bedridden Hospitalized Patient......Page 679
Outpatient Health Summary......Page 680
Outpatient Osteopathic SOAP Note History Form......Page 681
Outpatient Osteopathic Assessment and Plan Form......Page 683
Conclusion......Page 684
Connective Tissue......Page 685
Lymphatic Drainage......Page 687
Sympathetics......Page 688
Olfactory Nerve (I)......Page 692
Optic Nerve (II)......Page 693
Oculomotor Nerve (III)......Page 694
Trigeminal Nerve (V)......Page 695
Adbucens Nerve (VI)......Page 696
Auditory Nerve (VIII)......Page 697
Vagus Nerve (X)......Page 698
Fourth Ventricle......Page 699
Eye......Page 700
Common Cold......Page 702
Headache......Page 703
Migraine......Page 704
Traction and Inflammatory Headache......Page 705
Cranial Neuralgias......Page 706
Conclusion......Page 708
Ligamentous......Page 709
Motion Biomechanics......Page 710
Occipital Motion Testing of C0-1......Page 711
C2-7 Motion Testing......Page 712
Clinical Information......Page 713
Conclusion......Page 714
Skeletal and Arthodial Structures......Page 715
Arterial Supply......Page 716
Lymphatic Drainage......Page 717
Reflexes......Page 719
Motion Testing......Page 720
Configuration and Physiologic Motion......Page 721
Configuration and Physiologic Motion......Page 724
Somatic Dysfunction of the Hand......Page 725
Drop Arm Test......Page 726
Carpal Tunnel Syndrome......Page 727
Myofascial Triggers......Page 728
Conclusion......Page 729
Thoracic Region......Page 730
Muscles of the Thoracic Area......Page 731
Connective Tissue and Fascia......Page 735
Neural Connections of the Thoracic Area......Page 736
Vertebral and Costal Cage Motion......Page 737
History and Physical Examination......Page 738
Examination......Page 739
Active Motion Testing of the Vertebral Motion Segment......Page 740
Diagnosis......Page 741
Conclusion......Page 742
The Costal Skeleton......Page 743
Muscles of the Costal Area......Page 744
Rib Mechanics......Page 745
History......Page 746
Evaluation for Structural Rib Dysfunction......Page 747
Sternum Evaluation......Page 749
Conclusion......Page 751
The Anterior Element......Page 752
The Posterior Elements......Page 754
Ligaments......Page 756
Muscles and Fascia......Page 757
Spinal Cord and Lumbar Nerves......Page 758
Vasculature and Lymphatics......Page 760
Motion......Page 762
Physical Examination......Page 764
Specific Tests......Page 765
Clinical Examples: Treatment for "Back Pain"......Page 768
Conclusions......Page 775
Historical Perspective and Supportive Evidence......Page 776
Ligaments, Muscles, and Fasciae......Page 777
Somatic Pain Caused by the Percutaneous Reflex of Morley......Page 778
Topographic Anatomy......Page 779
Patient History......Page 780
General......Page 781
Treatment Goals......Page 782
Paraspinal Inhibition......Page 783
Collateral Ganglia Inhibition......Page 784
Conclusion......Page 785
Skeletal/Ligamentous Anatomy......Page 787
Primary Muscles......Page 788
Secondary Muscles......Page 789
Vascular/Lymphatic Anatomy......Page 790
Nerves......Page 791
Sacrum......Page 792
Normal Motion of Walk Cycle......Page 793
Diagnosis by History and Physical Examination......Page 794
Neurologic Examination of Pelvic Region......Page 796
Special Tests of Pelvis......Page 797
Supine......Page 798
Iliosacral Somatic Dysfunctions......Page 802
Diagnosis of Sacroiliac Dysfunction......Page 803
Posterior Sacrum......Page 804
Conclusion......Page 807
Skeletal, Arthrodial, and Ligamentous Structures and Function......Page 809
Ligamentous Sprain Classification......Page 810
Longitudinal Axis......Page 811
Motion......Page 812
Knee......Page 814
Q-Angle and the Patella......Page 816
Ligaments and Cartilage......Page 817
Motion......Page 818
Ankle......Page 819
Subtalar Joint......Page 820
Pes Planus and Pes Cavus......Page 821
Lateral Stabilizing Ligaments and Ankle Sprains......Page 822
Transverse Arch......Page 823
Transverse Tarsal Joint......Page 824
Hallus Valgus, Bunions, and Hammer Toes......Page 825
Radiculopathy......Page 826
Referred Pain......Page 828
Muscles of the Thigh and Leg......Page 829
Hip......Page 831
Lower Leg......Page 835
Lateral Compartment......Page 838
Bursae and Bursitis......Page 839
Conclusion......Page 842
54. SOFT TISSUE TECHNIQUES......Page 844
Forward Bending......Page 845
Longitudinal Traction......Page 846
Prone Pressure with Counterpressure......Page 847
Lateral Recumbent Thumb Pressure......Page 848
Supine Extension......Page 849
Supine Rotation with Counterleverage......Page 850
Prone Scissors Technique......Page 851
Lateral Recumbent......Page 852
Sacral Rock......Page 853
Posterior Axillary Folds......Page 854
Fascia Lata (Method 1)......Page 855
Piriformis......Page 856
Arch Springing......Page 857
Conclusion......Page 858
Diagnosis......Page 859
Rib Raising......Page 860
Indications......Page 861
Extension......Page 862
Flexion, Extension, Side-Bending......Page 863
Extension......Page 864
Side-Bending......Page 865
Lateral Recumbent......Page 866
Posterior Rib Raising......Page 867
Flexion (Lateral Recumbent)......Page 868
Extension (Lateral Recumbent)......Page 869
Side-Bending (Lateral Recumbent)......Page 870
Rotation to Innominate......Page 871
Rotation to Innominate......Page 872
Stage 2: Glenohumeral Extension/Flexion with the Elbow Flexed......Page 873
Stage 4: Cicumduction and Slight Compression with the Elbow Flexed/Extended......Page 874
Comments on Spencer Shoulder Techniques......Page 875
Conclusion......Page 876
Motion Loss and Somatic Dysfunction......Page 877
Quality of Motion......Page 878
Mechanism of Thrust Technique Action......Page 879
Accumulation of Force at Restriction......Page 880
Precautions and Contraindications......Page 881
Cervicals......Page 882
Thoracic......Page 884
Ribs......Page 889
Thoracolumbar Region......Page 893
Pelvis......Page 896
Upper Extremity......Page 899
Lower Extremity......Page 900
Conclusion......Page 904
History......Page 906
Joint Mobilization Using Muscle Force......Page 907
Sequence......Page 908
Conclusion......Page 909
Spinal Segmental Somatic Dysfunction......Page 910
Costal Somatic Dysfunction......Page 915
Innominate Dysfunction......Page 919
Sacrum......Page 922
The Extremities......Page 925
Connective Tissue Continuity......Page 933
Treatment Considerations......Page 934
Lower Body......Page 935
Upper Body......Page 937
Conclusion......Page 939
Ligamentous Articular Mechanisms......Page 941
Principles of Diagnosis......Page 942
Principles of Treatment......Page 943
Pelvis: The Differential Technique......Page 944
Innominates......Page 945
Hip Capsule......Page 946
Ribs......Page 949
First Rib......Page 950
Humerus/Glenohumeral Joint......Page 951
The Lower Cervical Spine......Page 952
The Upper Cervical Spine......Page 953
Acknowledgments......Page 955
Definition......Page 956
Force Effects......Page 957
Sensing Positional and Movement-Related Asymmetries......Page 958
Pain at Loose Sites......Page 959
Indirect Myofascial Release......Page 960
Lumbosacral Spine and Pelvis......Page 961
Craniocervical Spine......Page 977
Lower Limb......Page 981
Foot and Ankle......Page 986
Upper Limb and Shouldler......Page 987
Forearm, Elbow, and Wrist Release......Page 989
Wrist-Forearm-Elbow......Page 990
Carpal and Palmar Tunnel Release......Page 991
Conclusion......Page 993
Historical Perspectives......Page 994
Functional Technique......Page 998
Conceptual Basis......Page 999
Thoracic, Lumbar, and Sacral Regions: Seated......Page 1000
Cervical Region......Page 1001
Costal Region......Page 1002
Thoracic Cage: Differentiating Somatic and Visceral Inputs......Page 1005
Innominate......Page 1006
Appendicular Regions......Page 1007
Conclusion......Page 1008
History......Page 1010
Inherent Motility of Brain and Spinal Cord......Page 1011
Involuntary Mobility of Sacrum Between Ilia......Page 1012
Mobility of Intracranial and Intraspinal Membranes......Page 1013
Articular Mobility of Cranial Bones: Research......Page 1014
Mechanics of Physiologic Motion......Page 1015
Strains......Page 1017
Patient History......Page 1018
Neonatal......Page 1019
Dentistry......Page 1021
Goals of Treatment......Page 1022
Conclusion......Page 1025
History......Page 1027
Theoretical Physiologic Basis of Counterstrain......Page 1028
Find a Significant Tender Point......Page 1029
Position the Patient for Maximum Comfort......Page 1030
Instructions to Patients......Page 1031
Cervical Spine......Page 1032
Thoracic Spine......Page 1034
Ribs......Page 1036
Lumbar Spine......Page 1037
Pelvis......Page 1038
Upper Extremities......Page 1039
Acknowledgments......Page 1040
Theory of Effectiveness......Page 1042
Cervical......Page 1043
Thoracic......Page 1044
First Rib......Page 1045
Lumbar......Page 1047
Conclusion......Page 1049
Inhibition......Page 1051
Osteopathic Point and/or Pressure Techniques......Page 1052
Progressive Inhibition of Neuromuscular Structures Method......Page 1053
Procedure......Page 1054
Contraindications and Side Effects......Page 1057
Conclusion......Page 1058
Myofascial Trigger Points in Osteopathic Practice......Page 1059
Incidence......Page 1062
Referred Pain Mechanisms and Causation......Page 1063
Diagnosis......Page 1064
Treatment......Page 1065
Injection......Page 1066
Trigger Points Affecting Regional Somatic Functions......Page 1067
Impairment of Venous and Lymphatic Drainage......Page 1070
Autonomic Effects of Traveell Myofascial Points......Page 1072
Association with Viscerosomatic and Somatovisceral Reflexes......Page 1073
Conclusion......Page 1074
Distinguishing Characteristics......Page 1076
Specific Reflexes to Seek and Treat......Page 1077
Conclusion......Page 1080
Embryologic Development......Page 1081
Organized Lymph Tissues......Page 1082
Lymph Channels......Page 1083
Fluid Balance......Page 1084
Mechanisms of Flow......Page 1085
Goals......Page 1086
Lymphatic Manipulative Techniques......Page 1087
Open Thoracic Inlet Fascia......Page 1088
Normalize Sympathetic Activity......Page 1089
Thoracoabdominal Diaphragm......Page 1090
Dome Pelvic Diaphragm......Page 1092
Pump Techniques......Page 1093
Abdominal and Pedal Pumps......Page 1094
Liver and Spleen Pump Techniques......Page 1095
Direct Pressure Techniques to Move Lymph......Page 1096
Cervical Soft Tissue......Page 1097
Abdominal......Page 1098
Extremities......Page 1100
Conclusion......Page 1102
Theory......Page 1103
The Lower Esophagus, Stomach, and Duodenum......Page 1104
Small Intestine Motility......Page 1106
Root of Sigmoid......Page 1107
Liver......Page 1108
Liver, Frontal Plane......Page 1109
Gallbladder......Page 1110
Kidney......Page 1111
Pancreas......Page 1112
Cervical-Pleural Ligaments......Page 1113
Bronchi......Page 1114
Bladder......Page 1115
Cervix......Page 1116
Knee/Elbow Position......Page 1117
Diagnosis......Page 1119
Occipital-Altas......Page 1120
Superior (Elevated) First Rib......Page 1121
Inferior (Depressed) First Rib......Page 1122
Upper Thoracic Vertebra Type II Dysfunction......Page 1123
Ribs (Below Rib 1)......Page 1124
Solitary Posterior Rib......Page 1125
Anterior Rib......Page 1126
Flexed Lumbar Segment......Page 1127
Ilium or Innominate......Page 1128
Posterior Left Iliosacral Dysfunction (Left Posterior Innominate)......Page 1129
Upslipped Innominate......Page 1130
Pubic Ramus Dysfunction......Page 1131
Sacrum......Page 1132
Diagonal Right Sacroiliac Dysfunction......Page 1133
Hip Muscles......Page 1134
Right Gluteus Maximus Dysfunction......Page 1135
Right Gluteus Medius and Minimus Dysfunctions......Page 1136
Right In-Rotated Scaphoid......Page 1137
The Knee......Page 1138
Anterior Fibular Head Dysfunction......Page 1139
Assessing for Segmental Faciliation......Page 1140
The Thorax......Page 1145
The Abdomen......Page 1146
Inflammation......Page 1148
Segmental Facilitation......Page 1149
Neuroendocrine Immune Considerations......Page 1151
Approach to Thorax......Page 1152
Approach to Abdomen/Pelvis......Page 1156
General Considerations......Page 1159
Specific Manipulative Treatment Techniques......Page 1160
Paravertebral Ganglia Techniques......Page 1161
Thoracic Region Techniques......Page 1162
Abdominal Treatment Techniques......Page 1164
Lymph Mobilization......Page 1165
Acknowledgment......Page 1167
Efficacy of Manipulation......Page 1168
Low Back Pain......Page 1170
Systemic Disease......Page 1171
Incidence......Page 1172
Muscle Energy......Page 1174
Osteopathic Practice Guidelines......Page 1175
Conclusion......Page 1176
Facilitation......Page 1178
Mechanoreceptors......Page 1179
The Spinal Cord Response to Nociception......Page 1180
Myofascial Responses to States of Immobilization......Page 1181
Some Proposed Effects of Osteopathic Manipulative Treatment in Relation to Somatic Dysfunction......Page 1182
Strain-Counterstrain......Page 1183
Summary and Conclusions......Page 1184
SECTION VIII: BASIC AND CLINICAL RESEARCH FOR OSTEOPATHIC THEORY AND PRACTICE......Page 1188
The Second Period of Research (1940-1969)......Page 1192
The Third Period of Research (1970 to 2000)......Page 1193
How Do Researchers Become Aware of the Theory or Clinical Aspects of the Profession?......Page 1194
Major Institutional Review Board Considerations......Page 1195
Basic Research in Other Institutions and Professions......Page 1196
Qualitative Studies in Osteopathy......Page 1197
The Irvine Study Compared with Clinical Trials of Medical Interventions......Page 1198
Functional Outcomes of Manipulative Treatment......Page 1199
Literature Search......Page 1200
The Hypothesis......Page 1202
Other Observational Study Designs......Page 1203
Random Assignment to Groups......Page 1204
Data Analysis......Page 1205
Discussion......Page 1206
Special Considerations in Osteopathic Clinical Research......Page 1207
Validity and Bias......Page 1208
Control Groups......Page 1209
Dependent Variables......Page 1210
Conclusion......Page 1211
History......Page 1213
Interexaminer Agreement and Somatic Dysfunction......Page 1214
Clinical Correlations......Page 1215
Conclusion......Page 1217
Evaluation of Osteopathic Health Delivery......Page 1219
Hypothesis Testing......Page 1220
Study Design......Page 1221
Outcomes Research in the Realm of Osteopathic Medicine......Page 1223
Conclusion......Page 1225
Biobehavioral Mechanisms in Health......Page 1228
Disease Development (Pathway "A")......Page 1229
Immune Function and Infectious Disorders......Page 1230
Disease Risk (Pathway "B")......Page 1231
Placebo as a Biomechanical Mechanism......Page 1232
Starting the Research Process......Page 1233
Quantitative Measurement......Page 1235
Statistical Analysis......Page 1236
Summary......Page 1237
Phase I Clinical Trials......Page 1240
Research Questions, Research Designs, Sample Size, and Data Analysis......Page 1241
Data Analysis......Page 1242
Conclusion......Page 1243
Osteopathic Research 2002......Page 1244
Academic Challenges: The Schools......Page 1245
Academic Challenges: The Faculty......Page 1246
Academic Challenges: The Students......Page 1247
Collaborative Challenges: Building Research Networks......Page 1248
Shams and Placebos......Page 1249
Basic Research......Page 1250
Challenges of the Bigger Picture: Osteopathic Philosophy and Larger Research Questions......Page 1251
Health Benefits of Manipulative Treatment......Page 1252
Conclusion......Page 1253
GLOSSARY OF OSTEOPATHIC TERMINIOLOGY......Page 1254
APPENDIX I: CRANIAL NERVES: ACTIONS AND USUAL SOMATIC DYSFUNCTIONS ACTIVATING SYMPTOMATOLOGY......Page 1280
SUBJECT INDEX......Page 1288