Initial OMM Made Easy

Initial omm

hi I'm Casey pollen I'm a medical student hi I'm Natalie holic and I'm a third-year osteopathic medical student today we're going to give you a brief introduction of what osteopathic medicine is and what it means to be an osteopathic physician a doctor of Osteopathic Medicine is a fully licensed physician that is capable of specializing in any field of medicine what makes an osteopathic physician unique is our holistic approach to patient care and our incorporation of osteopathic manipulative medicine otherwise known as OMM osteopathic physicians emphasize patient centered care which is an all-encompassing approach to disease diagnosis and management knowing that no part of the body acts in isolation we also understand that no disease process is limited to one organ system of the body for example alcohol induced liver failure prevents the ability of the liver to remove toxins from the body these toxins can cause altered Mental Status and impaired neurologic functioning furthermore the liver is unable to produce proteins normally found in the blood resulting in bleeding issues and whole body swelling the overall malnutrition associated with liver failure impairs the maintenance of bone muscle and other connective tissues lastly the social ramifications of chronic disease and addiction are many you can clearly see the interplay of the liver and the other organ systems of the body being conscientious of this interdependence ensures that we are thorough in our diagnosis and allows us to generate rational treatment plans om is an integral part of the osteopathic evaluation it involves palpation of the musculoskeletal system to gather information and implement manual techniques to facilitate the healing process while we use the musculoskeletal system to evaluate patients OMM is not limited to musculoskeletal complaints OMM can be used to treat ailments ranging from muscle strains to the symptoms of heart failure our osteopathic coursework is an inherently hands-on curriculum within the first few weeks of osteopathic medical school students become comfortable with physically contacting their patients through learning how to evaluate and treat their partners this level of comfort translates into a stronger patient provider relationship in the hospital setting medical students can feel limited and their ability to contribute to patient care because we are unable to prescribe medicine do many procedures or make executive decisions however so the implementation of OMM osteopathic medical students are able to provide impactful treatments and get immediate and lasting relief in other words we can do Oh mmm now as students the same skill set distinguishes us as osteopathic physicians when we incorporate OMM in the everyday care of our patients hopefully this has given you an idea of what osteopathic medicine is and what it means to be a DL we encourage you all to learn more about our profession and see if it is a good fit for you now that we've talked about what it is to be an osteopathic physician we thought we would demonstrate a little bit of osteopathic manipulative medicine this is going to be a truncated approach but it should give you a bit of a gist of how we would approach a patient so first thing we'd always want to take a detailed history so I react when T to Natalie and I'm aware that she is an osteopathic medical student and as all students are in medical school she spends a lot of hours studying and oftentimes we don't have the best posture when doing it so now he tells me that she has a bit of mid to upper back pain and stiffness in her upper back that gets worse when she studies so being aware of how her habits gives me some insight into what may be causing her back pain so we're going to move on and demonstrate how we would approach this complaint of back pain from a structural perspective so first I'm going to have Natalie turn and face to the side we're going to examine the curves of the spine normally we have a lordosis or anterior curving of the cervical spine a kyphosis and posterior curving a little the thoracic spine and the lordosis or answer you're curving of the lumbar spine in Natalie's case if I approach come to the side and take a look she has fairly normal cervical lordosis a bit of a pronounced transition to the thoracic kyphosis and her thoracic kyphosis is a little bit flattened but pronounced here at this upper region I also would assess her range of motion going to move on though and demonstrate the Palpa tori component of how we would assess this area so first I'm just going to feel for the muscles that are on either side of her spine we called the paraspinal muscles being thoughtful and conscientious with my palpation I asked Natalie to tell me if any area that eye contact is tender or painful so in this area where we caught it would be at about level of t5 and the thoracic spine she says it feels a little bit uncomfortable and when I feel there the muscles feel tighter to me and less compliant they're also a little bit more prominent on the right side compared to the left when we look for things like asymmetry I can continue through and palpate down this area it's a little bit more compliant in this mid to lower thoracic region then I compare and check on her left side it's tender here a little bit more or less than the other side less tender on her left I also want to be conscientious of the positioning of her ribs so I can ask Natalie to hug yourself and I'm going to feel along the contour what we call the rib angles the most posterior or prominent aspect of ribs I compare the two sides to each other so how does this feel there is that pretty tender so as I feel along the curve here this rib about rib 4 is more prominent and the muscles around the rib feel tighter to me and she's confirmed that that is a bit tender as well and we also know that it's asymmetric as it's more prominent on that right side and again here on the right ok so let's have you relax the last component will demonstrate is how we come up with we call a segmental diagnosis so as you're probably aware the spine is made up of multiple vertebral bodies and we are capable to of palpating each level and identifying if there's any mal positioning or mal rotation of any segment and identifying that and making a diagnosis so we noted the most dysfunction in the area of about t5 so I have a landmark here that I can palpate on the scapula and I come to the midline which I know to be at about the level of t3 I'll come down one level and down one more level to t5 and using my thumbs i palpate a little bit laterally or out to the side of the spinous processes onto the transverse processes and when I press anteriorly I feel that her right side is more prominent so that means that her vertebral body is rotated a little bit to the right now I asked Natalie to bender head for word until I feel that motion there okay relax and that becomes more symmetric to me feels that when she bent forward if the spine itself curved a little bit more towards the midline and I asked her to come back to neutral and then extend her head back and look up towards the ceiling and when she does that and you can relax it feels that that right side becomes even more prominent so it does not favor to be in that position we would call that a position of restriction however when making a diagnosis we talked about the position of ease so my concluding my conclusion would be that at the level of t5 she is flexed because it preferred to go in flexion rotated right and side bent right and that's due to what we call Fri its principles I'm going to spare you the details on that for now so we have multiple modalities that we can implement to treat this I'm going to demonstrate for you a technique we call hv la or high velocity low amplitude technique is what you may also see as a thrusting type technique or if you've heard somebody comment about this do pops my neck we try to avoid that type of language but as part of what can happen when performing this maneuver now before I do that I want to make sure that the muscles in the area are a little bit relaxed because I'm focusing on the joints with my HDL a technique so first I'll have Natalie lay on her left side facing the back wall and I'll come around here so I'm gonna make sure that my table height is good for me because as a physician I want to make sure that I take care of my body so that I can take care of my patients so her complaint was in this mid thoracic region so I'm going to treat that with soft tissue so I'm going to take her upper extremity and drape it over my upper arm I feel for her spinous processes and I come just lateral to that along the paraspinal musculature using my finger pads which give me broader contact and not my fingertips or fingernails I can engage those muscles and just using my bodyweight lean back and stretch those muscles I'm being conscientious that I'm not rolling over the muscles so that that type of motion is that can actually be a bit noxious and painful for our patient so I'm going to engage these tissues until I fill them start to relax and become more compliant the area under my hands is also getting a little bit warmer as we're increasing blood flow to this area and blood retains the heat that it gets from the central part of our body it would also probably be able to appreciate a bit of redness in this area as we increase the blood flow as I move to the lower part of the thoracic spine I transition her arm over my inferior arm and I continue to engage those muscles I feel like the area is beginning to relax and become more compliant this point I'm prepared to transition to my hvl a manoeuvre to do that I'll have Nathalie lay on her back and screwed towards me on the side of the table go actually going to take the table down a little bit because I need to be able to put my bodyweight over the top of the table so her dysfunction was on her right side so I'm going to take her arms and cross them across her body I will now rotate her towards me finding my landmark coming to the t3 moving down the t4 and t5 I place my thumb underneath that posterior transverse process I then put her body back on top of my hand I'm going to engage her elbows into my epigastrium so that brings my body weight over her midline and then while sweeping her hair out of the way we'll grab her head and neck and draw that into flexion till I feel motion at the dysfunctional segment I'll then draw her head towards me to engage side bending restriction at this point I'll ask Natalie to take a large breath in and and have it be all the way out as she does so I localize over the segment and then apply a quick brief posterior thrust I then have a relaxed on however sit up and I would retest so if you could face forward we always want to be sure that our modality has achieved reduction of the dysfunction that we first identified I have you bend forward for me and extend back that becomes much more symmetric and extension which it did not like to do earlier how is your pain over here her pain is decreased as well you might not been able to appreciate it but with the thrusting maneuver I performed I was able to hear multiple audible pops at the level underneath my hand so this concludes our demonstration of OMM along with a bit of the osteopathic approach and how we consider the patient's role in society and how it affects their body and function I hope you've appreciated this and learned a little bit more about our field of work