Osteopathic medicine is a philosophy.
It’s a world view. It’s a way
of looking at patients
and their problems.
And when you look at people, they don’t
live their life on one level all the time.
You can be a father, a son,
a spouse, and many of the
things at the same time.
The same way with your illness. It may
be musculoskeletal but have issues
that are involved with your
psyche or your breathing.
So the Educational Council in Osteopathic
Principles back in the early 80’s,
came up with a concept of
dealing with people
living their lives on multiple levels,
and having problems that
transverse multiple levels.
And when you get tested by the National
Board of Osteopathic Medical Examiners,
they want to know how you’re
using the models
to decide which therapeutic technique
you’re going to use,
how you’re going to use it,
and how it fits into
an explanatory model of health and illness.
We call this the Five Model Approach
to Osteopathic Medicine.
So the models sometimes overlap,
again, you can live your life in many
different levels all at once.
And it is important to address this
when you choose how you’re going
to treat somebody,
and how you’re going to think
about their problems,
and how you’re going to focus your attention
as a provider caring for a human being.
So we came up with a five model approach
of dealing with human beings,
of looking at people living their lives
in multiple ways, all at once.
The five models of manipulation are #1—
the biomechanical model—
basic mechanics of musculoskeletal movement,
how much motion you have,
and how much motion have you lost.
Then 2nd model is the neurologic model—
looking at the sympathetics, para-
and the innervation of the
and how the nervous system affects the body.
The 3rd system is the respiratory/
looking at how breathing is affected,
how comfortably somebody is breathing,
how their rib cage is moving,
how that’s effecting their functioning,
their breathing and heartbeat.
The 4th is a psychological model
and how is their mental status,
how is their functioning,
how are they thinking and feeling,
and how is their mood?
That’s going to affect how somebody
looks at their own health,
how they interpret individual symptoms,
and what that does to their exclamation
of what’s going on,
their explanation of their illness,
and how it effects their being.
And the last model is the bioenergy model.
How is their energy? How is their mood?
Are they sleeping? Are they eating?
How are they interpreting
and their approach and their
place in the world?
So those are the five models
And when somebody comes in with a complaint,
they could say, “My neck hurts,”
and that could be because their
neck doesn’t move.
It could be because they’ve
got a pinched nerve.
It could be because they didn’t sleep
and they have no energy and
they can’t wake up
despite how much coffee they drink.
It may be that they’re depressed.
So you can have multiple levels, but if
you’re going to address neck pain,
and say they can’t move and they ask you,
“How are you going to treat this?”
You’d say well I’m going to use
the biomechanic model
and I’m going to make sure that
they can’t twist more than 70°,
I’m going to get them to go to 90°.
Or if you say, “You know they
can move their neck
and I don’t think they’re functioning well
and they have tender points on their
forehead, on their anterior chest wall,
I’m going to look at the bioenergetic
model to evaluate the patient for
a fibromyalgia chronic fatigue or
some other bioenergetic
or somatic based syndrome
and address it in that way.”
Or you can say, “I’m going to mix
a couple of different models
lthough the treatments for each of
those models will be the same."
That’s why we have the models. It gives
you a way of making a decision
and choosing a path that will be
When you have somebody who
comes to you with an issue,
with a complaint that doesn’t
fall into a specific issue—
it’s not chest pain, it’s not
shortness of breath—
you want to start looking at where
am I going to place this problem.
Do they have a somatic dysfunction?
Do they have a psychological issue?
Do they have an energy issue? Is it just
normal variation in functioning
and is the person aging and
not accepting it?
So we have to figure out where it fits
and how we’re going to go with it
and how we’re going to manage it.
Are we going to witness the
Are we going to intervene with
the patient’s symptoms?
Are we going to manage symptoms
and somehow try to get them
to a better place
and when do we start applying
the specific skills we learned in osteo-
pathic manipulative therapy
and treatments to their issue?
And once we decide whether or
not to do something
with osteopathic manipulative treatment,
what technique do you use?
Do you use high velocity, low amplitude?
Do you use muscle energy? Is it something
that a counterstrain technique,
and if you’re going to use counterstrain,
how well does counterstrain work in
the biomechanical model?
It does. Is it the 1st choice? It could be.
But it’s one of the choices.
So with the manipulative prescription,
how often is this person going
to come for treatment?
How often does this person
want to come for treatment?
How important is the therapeutic
to helping them get better?
How much support do you give them?
This all figures in to figuring out
the amount of treatment and
how long treatment,
and what your goals are going to be?
What the patient will accept,
what the patient is looking for,
and what’s within the community standard
for providing care and support
to the patients.
We also want to look at the risk-
Some treatments will have downsides.
If somebody is older, do you want to
do high velocity, low amplitude?
If somebody has cancer, and
they’ve got bone mets,
what’s the risk of doing something direct
versus indirect in your treatment
So the five models helps you choose
which way you’re going to
go and your treatment.