00:01
Let’s review the five models
of osteopathic medicine.
00:04
The first model, probably the easiest one
to understand in a biomechanical sense,
is the biomechanical model
of osteopathic medicine.
00:12
What is the motion?
Can a person rotate 90°, rotate
90°, sidebend 45°,
flex to 90° and extend to 15°?
Do they have a full range of motion?
If there is a blockage,
a limitation, then that’s something
you should think about.
00:28
If they have symptoms in testing motion
where they’re not moving quickly enough
or smoothly enough where
they’ve got a tremor,
or they’ve got areas that just feels stiff
and they can get through if
you give them time.
00:42
Should you give them time?
Is it just the number of degrees of motion?
This all falls under the biomechanical
considerations.
00:51
What if you get a different response
every time you test somebody?
Or you get a different result
if you help them,
support them, or coach them?
They’re still having issues
with their biomechanics.
01:04
Is it going to be a straight
biomechanical model
and explanatory system for you?
Or are you going to get broader
in how you treat them?
Is there a good gait? Is there pain?
And in the biomechanical model,
about 67% of patients are going
to present with pain.
01:22
Some of those are going to be musculo-
skeletal in origin, some of it will not,
but all of it will decrease
their functional ability,
decrease their ability to reach their
maximal ability to do things,
and we want to help restore them to
an optimal level of functioning.
01:38
That’s the biomechanical model.
01:42
In treating somebody with a biomechanically-
related illness,
or an illness that you’re addressing
in the biomechanical model,
you want to make that you
measure joint motion,
and measure joint motion before
treatment, after treatment,
and between visits
to see how much of a benefit
you get that day
versus how much of that benefit sticks.
02:02
You want to see if the muscle tone
is getting more consistent
and more normal, and you want to see
if the patient is getting pain relief
and how they feel this is affecting them.
02:13
Are they getting the results they want?
In the biomechanical model,
you want to look at the muscles a lot more.
02:22
You want to look at the passive
range of motion,
the active range of motion,
and how close you get to
the physiologic barrier,
how much the muscles could move
the musculoskeletal system itself,
and the pathologic barrier—
the disease process has stopped you
from doing something, where is that?
Or the anatomic barrier or how much
can the patient potentially get
for what we expect them to be able to get
in motion and activity.
02:50
Because with the biomechanical model,
you’re going to check your success
based on how you affect
their range of motion,
how you affect their feeling
in their muscles
and whether or not they
have better movement,
smoother movement, and a more
ease of use of their muscles.
03:07
What techniques do you use in
the biomechanical model?
You can use a lot of different techniques.
03:13
You can use both direct
and indirect to help increase motion.
03:18
You can use balanced ligamentous tension,
you can use HVLA,
or anything that helps increase motion
would be an acceptable treatment modality.
03:30
So counterstrain, myofascial,
and facilitated positional release
all fall under common ways of treating
the biomechanical disorders
and manipulation.
03:42
Next, let’s look at the neurological model.
03:45
With the neurological model,
you want to look at
what’s affecting the person and it may
be related to their nervous system.
03:51
You want to look at the autonomic
nervous system,
the sympathetics, and the parasympathetics.
03:55
Is this patient having GERD?
Is this patient having trouble peeing
or increased frequency, decreased stream?
Are there issues that are affected
that you can treat that way?
Are they feeling warmer than everyone else,
colder than everyone else, or having
less energy than usual?
Have they had a change in
their sexual function,
their pattern, or their abilities?
Are there other issues like lightheadedness,
dizziness that may be related
to the nervous system
that you may want to address.
04:24
If so, then you want to consider
a neurological model
for addressing their issues
and the neurologic considerations
will include
making sure you understand
the neural functioning.
04:36
Are they having trouble that you
can treat with something,
and can you bring them back to
a normal level of functioning?
So you want to work things back.
Where are the symptoms
and is it related to a viscerosomatic,
somatovisceral, visceroviscero?
Is it that the organs are affecting
the body function
or the body function is
affecting the organs?
If it is viscerosomatic,
it may be that heartburn is effecting
the functioning of the ribs.
05:03
If it’s somatovisceral,
you may have somebody with a
sore arm, even a broken arm,
that’s then developing back pain
or urinary dysfunction
or change in activity levels.
05:14
So figure out how you’re going
to think about the problem
and the neurologic model, this
is one easy way to do it.
05:22
In the neurologic model, we
tend to focus treatment
on parasympathetic systems.
05:28
You want to do a lot of
suboccipital release.
05:30
You may consider cranial osteopathic
manipulative medicine
and anything that affects the craniosacral
impulse or the rhythm.
05:38
We’re going to put this under the
neurologic model of treatment.
05:43
Rib raising is a good treatment
that helps the sympathetic chain
ganglia reset themselves
and enhances functioning.
05:53
So these are some of the ways you can
treat somebody with a neurologic issue.
05:59
Moving on to the respiratory/
circulatory system.
06:03
Respiratory system is easy to see
if you’re paying attention to it.
06:08
When you’re examining someone,
are they having different patterns
or is it a consistent pattern of breathing.
06:14
Do they look like they’re working for
just their regular rate of living?
The poor protoplasm issue where somebody
just doesn’t look healthy.
06:23
Is this something that’s related
to functioning
that should be unconscious and going on
without the person having to
pay attention to it?
Often times in the cardiorespiratory model,
people get tired and they’re not
functioning easy or comfortably.
06:38
And they’re taking over and their
mind is overriding
what should be an unconscious
functioning of the body,
and in this case, they get tired.
06:47
If you have to think about breathing
and remember to breathe,
and breathe consciously, that’s a lot of work.
06:54
It affects how you function.
It affects how you think.
06:57
It’ll start to affect the comfort
of your muscles.
07:00
They’ll get boggier, more tender,
and more uncomfortable when they’re touched.
07:04
So in the respiratory/circulatory model,
you want to link those systems
in a viscerosomatic relationship.
07:14
How are the organs in the chest
affecting the body system?
Is there a change in the body structure?
Do they look different? Are they
developing a barrel chest?
Are they developing a change in the
AP diameter of their chest?
Are they showing other signs of rigidity
or decreased motion of
the neck and the chest
because when a lot of this
starts in the chest,
it expands quickly to the neck,
the shoulders, the arms,
and eventually other parts
of the body as well.
07:48
Treatment goals in somebody who’s
in the cardiorespiratory model,
we often focus on the lymphatic system.
07:52
We often focus on soft tissue.
07:55
We want to make sure that the
motion is optimized.
07:56
We want to make sure that the lymphatics
and that the circulatory system
does get paid attention to
and that we do help
by both assessing types of edema,
sites of edema,
and how much will an intervention matter.
08:10
The techniques we use are often myofascial;
thoracic outlet release focusing
on the thoracic outlet, inlet,
and thoracic apertures; pectoral traction
as well as diaphragmatic
doming and rib raising.
08:24
So those are all aspects of treatment
that you may want to consider
when somebody has a respiratory/circulatory
approach to what’s going on.
08:34
So again, attention to lymphatics,
attention to flow, attention to
fluid and tissue dynamics.
08:43
The fourth model is the psychobehavioral
model.
08:46
It’s the model that patients
are reluctant to accept
and it’s something that as a provider
you can talk to the patient and say,
“We notice that your energy
level is different
than you might want it to be
and that you may not be able
to do what you want to do,
and you may seem more depressed.”
And if the patient doesn’t buy into it
and doesn’t accept that worldview
and says, “No, no, no. I just need
my heartbeat sped up.
09:10
Give me some cocaine. Give me some alcohol.”
Those things will make—well we can’t
do exactly what they want,
but we can move from the psychobehavioral
model around
and include that with others
because your goal in the psychobehavioral
model
is to decrease disability.
09:26
It’s to get people to live
up to their potential.
09:28
To identify their potential and identify
that they’re not at their potential
and note what the gap is and
work with them to get there.
09:37
It is witnessing an issue
and sharing with the patient.
It’s leading the patient
through explaining what you’re seeing
and being a mirror for them
and for their behavior and
their psychological state.
09:50
So a difficult model to address in
our current environment
but a very important one.
09:55
And I think it is getting easier and more
accepting at this point in time.
09:59
And the last model, the fifth model,
is the bioenergetic model.
10:03
I look at this as the model of
the somatic syndromes—
the fibromyalgia, the chronic
fatigue, interstitial cystitis,
the non-cardiac chest pain syndromes.
10:15
All of these fall into a bioenergetic model
where people have a lot of fatigue.
10:20
Where people don’t have the energy
to do what they want to do
and they haven’t changed who they are
but they don’t have the same about of time.
10:29
So they may wake up in the morning
and have energy,
but are fatigued in 2 to 3 hours.
10:33
A lot of bioenergy is linked
to sleep-wake cycles.
10:37
It’s linked to energy
and it’s a model where people
accept what’s going on
because they note the difference
in their energy
and they’re very vigilant.
10:49
A lot of people I take care of who have
issues with the bioenergetic model
are high achieving, control-
oriented individuals
who want to know what’s going on
and they want to work on themselves
and getting there 24 hours a day.
11:03
They tend not to get restful sleep.
11:05
They tend not to be able to
rejuvenate themselves,
and as a result, they’ve got
chronic fatigue issues.
11:11
They’ve got use issues with their muscles
which make it more difficult
for them to function,
and bioenergetic models
may respond to a myofascial
approach. It may respond
to simpler approaches
where you’re trying to lead
them to a position of health
and to a role of understanding
where they need to let go sometimes,
where they need to rejuvenate,
what is under their control and what
isn’t under their control.
11:38
And again, witnessing issues
in a bioenergetic model are often helpful.
11:43
It often helps the patient understand
where their gaps are and where
they’re going to need help.
11:49
So in summary, there are
5 different worldviews,
5 different explanatory models
of health of illness
that we can use to help treat our patients.
11:59
All of them can be treated with
some form of osteopathic
manipulative treatment.
12:05
Different ones work better
under different models
but in taking care of people,
realize that people live in their lives
at many levels all at once.
12:13
That’s the way things are
going to be. It’s allowed,
understanding it and using
it to your advantage
can be very helpful
for developing a good therapeutic
relationship
and a successful outcome. Thank you.