Let’s talk terminology.
Here are the words you need to know
to speak osteopathic medicine ease.
The first term,
if you look at ICD-10,
what gets paid for;
it’s medical, surgical or osteopathic.
there is one thing they pay for,
and that is osteopathic
or osteopathic manipulative treatment.
So the diagnosis we use is
Diagnosing somatic dysfunction is an art.
It is understanding the body
and understanding when a person is
restricting their functioning
and not functioning at their optimal level—
when they’re not using a
body as effectively
or efficiently as they can.
So if the body is out of alignment;
if it isn’t twisting,
bending, flexing, or extending;
if it’s not moving fluidly, nicely
something is wrong with the body system.
That also, the muscles are organs.
They have endocrine functions.
They have movement functions
and they’re all going to be intertwined.
So the first definition is
It is an impaired or altered function
of related components of the somatic system
which includes the skeletal, athrodial,
and myofascial structures
and their related vascular, lymphatic,
and neural elements.
That’s a definition you need to memorize.
That’s a definition you need to know.
That’s a definition you’re going to
repeat again and again
because somatic dysfunction
is when you have impaired
or altered function
of related components of the body system.
It includes the skeletal,
the arthrodial or joints, the myofascial—
the muscles and fascia,
and their related vascular, lymphatic,
and neural elements.
These come together
to effect an organ—
and the bones are an organ and
the muscles are an organ—
and they each have their own functions,
their own structure,
and their own effect on the body.
We tend to look at them and say they’re
big organs, they move the body—
great, life is good—
but the philosophy of osteopathic
medicine is broader.
And the tenets, or the philosophy—the rules—
the underpinning ideology of
is that the body is a unit
and you have to look at the person
as both mind, body and spirit
and they all come together
to effect the individual
that we’re providing care for.
And if a person’s mind isn’t in it,
or their spirit is broken,
fixing their body is going to be temporary
and you don’t want to have someone come
in and make them feel better for 2 hours.
You want to understand why they’re
not able to be healthy,
why they’re not functioning fluidly,
and why they’re not comfortable.
The other 3 tenets we’re going to go through—
the body is capable of self-regulation.
Sometimes just fixing the functioning
of the body lets a person do better.
If they’re not sleeping well
and you help get them to sleep better,
they may do better overall.
So the body is a unit that is
capable of self-regulation,
self-healing, and health maintenance.
The next tenet is that structure
and function are interrelated.
If you are asymmetrical,
if you have a scoliosis,
if you have weakness in the low back,
if you have muscles that are larger on one
side or one part of the body than another,
it’s going to affect how you walk,
how you stand,
how you feel when you’re functioning,
and how long you’re able to function.
So those are important
and understanding the principles
of body unity
and regulation, and the interrelationship,
and structure, and function
should lead treatment.
So the tenets can be put into practice
with the principles of osteopathic medicine
and the principles are 3 basic principles.
The patient is the focus of the
healthcare being provided.
The patient has responsibility for
his or her own health.
We can’t fix something by moving a body part
and saying you’re done.
It’s a philosophy with particular
And that the efficient treatment
program for patient care
is founded on the 4 tenets.
So we’re working on structure and function,
we’re working on the musculoskeletal
that’s effecting more than just movement,
and we’ll get to that in the muscles
and bones lecture,
but all of these need to be put together.
And we’re talking terminology
that matters now.
If you want to diagnosis
I like to say there’s an art to it—
an art with 2 t’s—but an art none the less.
And if you look at somebody and
they don’t look symmetrical—
the shoulders are different,
length, they’re twisted,
they’re trying to get comfortable and
they just don’t look comfortable,
there’s no fluidity, and there’s no
clear rhythm to their motion,
then there may be a problem.
So you can notice asymmetry just from
looking at somebody in a static way,
although in a kinematic way with motion,
it’s easier to notice asymmetries coming out.
Asymmetries tend to get exacerbated.
They tend to get promoted in how you
see them when people are moving.
So every osteopathic exam and every
exam of the musculoskeletal system
should take place in at least 2 positions—
siting and standing, standing
and laying down,
sitting and moving, but you have
to watch somebody in motion
to appreciate abnormalities.
We are very biomechanically based so
the R is range of motion abnormalities
nd I can’t tell you how many times you’ve got
to twist somebody 90°, twist them 90°,
sidebend 45°, sidebend 45°,
flex to 90°, and extend to 15°.
If they can’t do that, there’s a range
of motion abnormalities.
“The doctor said, but I can do
much more—I can do 110°.”
Yes, not everybody is the same.
Some people have more motion.
Some people can work at doing more motion.
Some people can do splits and do 90°.
Some people can only do splits
with their fingers
or can’t even do splits with their fingers.
But the range of motion,
you have standards you have to follow.
There are standards that a body
should be able to do
and you can train the body to get to
and that’s the minimum of 90°, 90°,
45°, 45°, 90° and 15°.
And the last part of the ARTT of
diagnosing somatic dysfunction
is tissue texture changes,
temperature changes, and tenderness
of the muscles.
So if the muscle is tender,
and you notice when you touch
it they’re uncomfortable,
that’s a sign there may be a problem
in that part of the muscle.
It shouldn’t be tender.
People shouldn’t jump when you touch them.
You can notice differences in texture
so if you touch somebody and
you get little indentations,
or you feel soft spots like a rotten pear,
that’s a tissue texture change that
you have to pay attention to.
So that is the ARTT of diagnosing
It is asymmetry, range of motion,
and tissue texture changes
including temperature and tenderness.
So those are some basic terms.
Osteopathic medicine is a way of
applying medical science
to individuals seeking care.
It’s putting your philosophy into practice
and taking care of an individual
which includes structure and function
of the musculoskeletal system,
understanding that muscles
and bones are organs
that have effects beyond just motion,
and treating the person in that way.
It’s a science that includes
how a person and the environment interact.
And it’s trying to make life easier
and more comfortable
from the person you’re caring for.
Those are the basic concepts.