Five Models of Osteopathic Medicine

by Tyler Cymet, DO, FACOFP

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    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.

    About the Lecture

    The lecture Five Models of Osteopathic Medicine by Tyler Cymet, DO, FACOFP is from the course Osteopathic Principles and Tenets. It contains the following chapters:

    • Biomechanical Model
    • Neurological Model
    • Respiratory/Circulatory Model
    • Psycho-behavioral Model
    • Bioenergy Model

    Included Quiz Questions

    1. Bradykinesia
    2. Tremor
    3. Rigidity
    4. Postural instability
    5. Shuffling gait
    1. Balanced ligamentous tension
    2. ROM technique
    3. Myofascial release
    4. Facilitated positional release
    5. Counterstrain
    1. Counterstrain
    2. Balanced ligamentous tension
    3. ROM technique
    4. Myofascial release
    5. Facilitated positional release
    1. Myofascial release
    2. Balanced ligamentous tension
    3. ROM technique
    4. Counterstrain
    5. Facilitated positional release
    1. Rib raising
    2. Balanced ligamentous tension
    3. Cervical myofascial release
    4. Suture spread
    5. Suboccipital release
    1. Camptocormia
    2. Barrel chest
    3. Osteoporosis
    4. Kyphosis
    5. Lordosis

    Author of lecture Five Models of Osteopathic Medicine

     Tyler Cymet, DO, FACOFP

    Tyler Cymet, DO, FACOFP

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    Understanding the Five Model Approach
    By Grant D. on 30. November 2019 for Five Models of Osteopathic Medicine

    One of the most useful lectures in this series! I have always had trouble understanding how to use the 5 models, but in this video, Dr. Cymet did a fantastic job at breaking down the purpose of the 5 model approach, the meaning behind each model, and gave great examples for how and when each model should be used.