Osteopathic Manipulative Medicine (OMM): Critical Concepts

by Tyler Cymet, DO, FACOFP

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    00:01 Let’s talk terminology.

    00:03 Here are the words you need to know to speak osteopathic medicine ease.

    00:09 The first term, if you look at ICD-10, what gets paid for; it’s medical, surgical or osteopathic.

    00:17 Under osteopathic, there is one thing they pay for, and that is osteopathic manipulative therapy or osteopathic manipulative treatment.

    00:27 So the diagnosis we use is somatic dysfunction.

    00:32 Diagnosing somatic dysfunction is an art.

    00:34 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.

    00:49 So if the body is out of alignment; if it isn’t twisting, bending, flexing, or extending; if it’s not moving fluidly, nicely or comfortably, something is wrong with the body system.

    01:01 That also, the muscles are organs.

    01:05 They have endocrine functions.

    01:07 They have movement functions and they’re all going to be intertwined.

    01:12 So the first definition is somatic dysfunction.

    01:15 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.

    01:27 That’s a definition you need to memorize.

    01:29 That’s a definition you need to know.

    01:31 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.

    01:44 It includes the skeletal, the arthrodial or joints, the myofascial— the muscles and fascia, and their related vascular, lymphatic, and neural elements.

    01:54 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.

    02:09 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.

    02:19 And the tenets, or the philosophy—the rules— the underpinning ideology of osteopathic medicine, 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.

    02:39 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.

    02:50 You want to understand why they’re not able to be healthy, why they’re not functioning fluidly, and why they’re not comfortable.

    02:59 The other 3 tenets we’re going to go through— the body is capable of self-regulation.

    03:04 Sometimes just fixing the functioning of the body lets a person do better.

    03:09 If they’re not sleeping well and you help get them to sleep better, they may do better overall.

    03:14 So the body is a unit that is capable of self-regulation, self-healing, and health maintenance.

    03:22 The next tenet is that structure and function are interrelated.

    03:27 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.

    03:46 So those are important and understanding the principles of body unity and regulation, and the interrelationship, and structure, and function should lead treatment.

    03:58 So the tenets can be put into practice with the principles of osteopathic medicine and the principles are 3 basic principles.

    04:09 The patient is the focus of the healthcare being provided.

    04:14 The patient has responsibility for his or her own health.

    04:19 We can’t fix something by moving a body part and saying you’re done.

    04:22 It’s a philosophy with particular procedures involved.

    04:28 And that the efficient treatment program for patient care is founded on the 4 tenets.

    04:33 So we’re working on structure and function, we’re working on the musculoskeletal organ system 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.

    04:47 And we’re talking terminology that matters now.

    04:50 If you want to diagnosis somatic dysfunction, I like to say there’s an art to it— an art with 2 t’s—but an art none the less.

    04:58 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.

    05:15 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.

    05:27 Asymmetries tend to get exacerbated.

    05:30 They tend to get promoted in how you see them when people are moving.

    05:35 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.

    05:51 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°.

    06:04 If they can’t do that, there’s a range of motion abnormalities.

    06:07 “The doctor said, but I can do much more—I can do 110°.” Yes, not everybody is the same.

    06:14 Some people have more motion.

    06:15 Some people can work at doing more motion.

    06:18 Some people can do splits and do 90°.

    06:21 Some people can only do splits with their fingers or can’t even do splits with their fingers.

    06:25 But the range of motion, you have standards you have to follow.

    06:29 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°.

    06:43 And the last part of the ARTT of diagnosing somatic dysfunction is tissue texture changes, temperature changes, and tenderness of the muscles.

    06:53 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.

    07:01 It shouldn’t be tender.

    07:02 People shouldn’t jump when you touch them.

    07:06 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.

    07:17 So that is the ARTT of diagnosing somatic dysfunction.

    07:22 It is asymmetry, range of motion, and tissue texture changes including temperature and tenderness.

    07:30 So those are some basic terms.

    07:32 Osteopathic medicine is a way of applying medical science to individuals seeking care.

    07:38 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.

    07:52 It’s a science that includes how a person and the environment interact.

    07:57 And it’s trying to make life easier and more comfortable from the person you’re caring for.

    08:03 Those are the basic concepts.

    About the Lecture

    The lecture Osteopathic Manipulative Medicine (OMM): Critical Concepts by Tyler Cymet, DO, FACOFP is from the course Osteopathic Principles and Tenets.

    Included Quiz Questions

    1. Somatic dysfunction
    2. Psychological dysfunction
    3. Endocrine dysfunction
    4. Muscular dysfunction
    5. Systemic dysfunction
    1. Patient
    2. Disease
    3. Condition
    4. Illness
    5. Symptom
    1. Patient
    2. Physician
    3. Spouse
    4. Partner
    5. Provider
    1. Asymmetry
    2. Biomechanical changes
    3. Temperature change
    4. Tissue texture changes
    5. Tenderness to palpation

    Author of lecture Osteopathic Manipulative Medicine (OMM): Critical Concepts

     Tyler Cymet, DO, FACOFP

    Tyler Cymet, DO, FACOFP

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