OMM: The ABCs of Osteopathic Treatment in a Surgical Patient

00:01 Another way to look at your patient is to utilize the ABC's of osteopathic treatment.

00:07 So A stands for Autonomic.

00:09 So with autonomic, you want to balance sympathetic with parasympathetic innervation.

00:14 This will help to reduce pain and decrease any compression on nerves.

00:18 B stands for Biomechanics, or in the case of surgery, breathing.

00:22 We want to try to improve the function and decrease musculoskeletal restrictions to try to increase range of motion.

00:28 So you want to look at the biomechanics of different joints, the biomechanics of respiration and breathing.

00:34 also ties them to C which is Circulation.

00:36 So you want to try to improve circulation, circulatory flow and lymphatic flow.

00:41 This will help to eliminate waste, improve oxygenation, improve deliveries of medications and help to relieve congestion.

00:48 So we're gonna take a closer look at these 3 next.

00:50 So the neurologic approach is the autonomic approach.

00:55 So autonomic dysfunction is a part of every disease process.

00:59 Usually, if anybody has pain, if anybody has an infection, their sympathetics will be high.

01:05 They'll have hypersympathetic tone.

01:07 So, what we want to do is try to balance that with parasympathetic innervation.

01:12 And you also want to check for possible Chapman reflexes which are viscerosomatic reflexes.

01:17 So in looking at the neurologic approach, screening and checking for any sort of viscerosomatics, any sort of regions of compression that might affect sympathetic and parasympathetic outflow is really important.

01:30 So following the neurologic model, we want to try to provide osteopathic treatment so the body could acheive balance and regulate itself.

01:39 Again, you want to balance sympathetic and parasympathetics and try to decrease that hypersympathetic tone.

01:44 We want to correlate the presentation of the patient with possible viscerosomatic reflexes.

01:50 And so remember the organ map of the different organs and it's nerve roots that supplies sympathetics to it.

01:56 So, we can have viscerosomatic reflexes from the organ that express itself on the soma.

02:02 And so if I had a lung infection, I'm checking from T1 to T6 to see if I have a possible acute viscerosomatic reflexes.

02:09 I'm also checking in the intercostal spaces of the 3rd and 4th intercostal space to see if there's a possible Chapman reflex.

02:17 So, based on the organ and the patient's presentation, you want to screen for possible viscerosomatic reflexes.

02:25 If you find those viscerosomatic reflexes, you want to treat it with very gentle techniques.

02:30 You don't want to do any direct or active techniques that may aggraviate their pain.

02:35 So B stands for the Biomechanical approach.

02:38 The biomechanical approach is to address the musculoskeletal system including the skeleton, the ligaments and the fascia and the muscles.

02:46 And so, we're applying gentle techniques to try to help decrease any sort of restrictions in these structures.

02:53 By treating these areas, we're gonna try to restore range of motion.

02:57 It helps to balance muscle tone.

02:59 And then that improves the motion between the fascial layers and that in turn, promotes movement of the thoracic cage and then respiration.

03:08 So C stands for Circulatory and Lymphatic approach.

03:11 And so, with this model, what we're trying to do is to address and improve circulation and lymphatic flow.

03:18 All disease processes have inflammatory process related to it and so maximizing circulation and lymph flow could help address and decrease inflammation.

03:29 Our immune system is also tied to our lymphatic system.

03:32 By promoting lymph flow, we could boost our body's ability to circulate our immune cells and improve our immunity.

03:40 The ability of our body to heal really depends on proper circulation and clearance of those inflammatory mediators.

03:47 And the problem is, hospitalized patients have more factors that limit their ability to move.

03:51 And so remember that movement is a major propeller of lymph and so is breathing.

03:57 And so patients who are hospitalized generally have different lines, IV's, you know, compression boots around their legs.

04:04 And so, they tend not to move as often and they're more confined to their bed and room And so you're moving a big factor that helps to move lymphatics.

04:13 In addition, they may have decreased excursion of breathing.

04:16 And remember that diaphragm and breathing is a major mover of lymphatics.

04:20 When we breathe, we change the intra-thoracic pressure .

04:24 and allow for return of lymphatic circulation back to the thoracic cage.

04:29 And so, when we have decreased excursion of breathing, that limits our patient's ability to move lymphatics.

04:37 So the respiratory system has a huge impact on the movement of fluids, the blood, the lymphatics.

04:44 We need to address any sort of skeletal muscle restrictions including the diaphragm to help promote proper lymph drainage.

04:52 We want to improve the thoracic cage function and thus it'll improve lymphatic flow.

04:57 So the overall goal of circulatory and lymphatic approach is to assist the removal of metabolic waste and to improve the delivery of medications and to also enhance the immune system.

05:09 So, treatment for the circulatory lymph approach.

05:13 First, we always look at the thoracic inlet release.

05:16 This is first to try to help remove any restrictions from terminal lymph drainage.

05:20 We also want to look at the abdominal and pelvic diaphragms.

05:24 We want to try to open up the thoracic cage to treat any restrictions of the ribs and the spine.

05:29 And also, apply lymph pump techniques if indicated.

05:34 So there are different precautions that we have to take when treating our patients in the hospital.

05:39 First and foremost, we have to make sure that they are medically stable.

05:42 We want to make sure we want to rule out any acute pathology such as myocardial Infarction, pneumothorax, pulmonary embolism, GI bleeds.

05:50 We don't want to put our patient at risk and so they need to be managed medically first.

05:55 We want to try to avoid direct and painful techniques.

05:58 Again, we don't want to increase facilitation.

06:00 We don't want to increase any input to the spinal cord of pain.

06:04 We want to rule out any possible fractures or thrombus especially prior to performing any sort of palm techniques or manipulating different joints.

06:13 And we want to try to avoid lines and open wounds.

06:15 And so, a hospitalized patient will usually have perhaps a foley cathether, IV lines.

06:21 They might have had surgery that had incision sites.

06:25 So, be very mindful of those things With your hand placement, with your body placement and how you approach the patient, in order to avoid pulling the lines or causing more injury or pain.

06:38 Try to maintain patient privacy and modesty.

06:43 When patients are in the hospital, a lot of times, they have a loss of independence.

06:48 They might be confused, they might be disoriented.

06:50 They might be very bombarded and overwhelmed by the situation.

06:55 and you might be the 20th healthcare provider that they're seeing and so, approach your patient with respect, maintain your privacy when performing the techniques.

07:04 Most of the patients are wearing a gown, if you need to, you could drape them prior to the techniques.

07:09 A nice way to try to treat the patient, especially their back, is to slide your hand between the bedsheets and the bed itself.

07:20 This will work better if you flip the gloves inside out so the powdery side will actually help you slide your hand underneath between the bed sheet and the bed itself.

07:33 Again, try to treat facilitated segments first.

07:36 Treat key areas.

07:38 Sometimes, you are not able to perform a very long teatment.

07:42 You want to try to keep the treatment short because the body is usually in an acute setting.

07:47 You may need to treat more frequently but not as long because the body could only tolerate so much.

07:56 So it's important to document your findings and the treatment modalities that you utillized in the chart after the procedure.

08:05 So OMT is a procedure, so it requires a procedure note.

08:08 You want to state within the procedure note that consent was obtained, that the patient responded to the procedure.

08:14 So an example is, "Patient tolerated the procedure well, had less swelling or less pain." So, utilizing the osteopathic models or the ABC's approach and taking special considerations into mind when approaching hospitalized patients could help you integrate OMT into the treatment of an acute care setting.