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OMM Treatment: Approaches

by Tyler Cymet, DO, FACOFP

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    00:01 We are going to start talking about the different types of manipulation.

    00:05 Talking about manipulation, manipulation is a class.

    00:09 It’s not a specific approach.

    00:11 It could include 7 different types of manipulation that are taught in DO schools.

    00:16 And sometimes, some approaches work for some things and other approaches work for other things.

    00:21 But it’s not one treatment for all, one size fits all.

    00:26 It’s multiple different approaches.

    00:28 So the osteopathic medical schools got together and said, “What do we teach? There are many different types. What is it that we have in common?” And the commonalities are all medical schools that give the DO degree teach 7 different types of manipulation.

    00:44 All of them start with an osteopathic neuromusculoskeletal exam.

    00:48 All of them teach counterstrain, which used to be called strain counterstrain or spontaneous release by positioning.

    00:55 All teach HVLA from the beginning.

    00:58 A.T. Still started teaching high velocity, low amplitude thrusting as a way of treating musculoskeletal disorders.

    01:05 Lymphatic treatments are generally one of the first treatments medical students are taught and they include effleurage and other types of manipulation.

    01:14 Muscle energy is another one.

    01:16 We use the activity of the muscle to loosen up motion and that's also taught at every osteopathic medical school.

    01:23 Myofascial release and myofascial treatment is another.

    01:28 Cranial osteopathic manipulative medicine is number 6 and number 7 is soft tissue treatments.

    01:36 If you want to learn more, there’s a lot more to learn.

    01:39 There’s always more to learn.

    01:41 If you want to learn different types—Still technique which is taking a person from position of ease and passive motion past a barrier; facilitated positional release; fascial distortion method; manipulation under anesthesia; articulatory treatments which are low velocity, high amplitude; Chapman’s reflexes— and even systemic or organ-based manipulation isn’t taught in osteopathic medical school, it’s taught in residencies.

    02:12 So when we talk about the osteopathic screening examination, we know that every examination needs to be done in at least 2 positions.

    02:20 We should do the posterior, anterior and lateral views to get a sense of the body’s proportion and the issues the patient may be having.

    02:28 We also know that you want to do every exam in 2 positions, so just examining them and looking at them in every position isn’t enough.

    02:36 A lot of times, you’ve got to get them supine, see how they stand, see how they move and see if you take the weight off the body if it functions differently.

    02:44 So in the supine manner, you may want to examine the cervical and thoracic inlet and outlet as well.

    02:52 When we try and divide up osteopathic manipulative treatments, we divide it up into direct treatments and indirect treatments.

    03:00 A direct treatment is if a person can’t rotate right, the treatment is going to rotate them right and do something to get them to rotate right better.

    03:09 It’s going to free up the motion in the area of the restriction, the area that it can’t go.

    03:14 That is a direct technique.

    03:16 An indirect technique is if you can’t turn right— let’s turn you left and pull your muscles until you can move more to the right, but that’s indirect technique.

    03:27 So the direct techniques are soft tissue techniques where you massage and treat the area where it’s an issue.

    03:36 Articulatory techniques; HVLA or high velocity, low amplitude; muscle energy; and inhibition techniques.

    03:43 Indirect techniques are techniques like facilitated positional release and counterstrain.

    03:51 If you’re looking at techniques that could be either, myofascial release could be either direct— pushing something to go where it doesn’t want to go—or indirect.

    04:00 Cranial osteopathic manipulative medicine is neither direct nor indirect because you’re using forces other than muscle forces to get the motion.

    04:07 Ligamentous articulatory release can be both direct and indirect.

    04:11 And the Still technique is also an indirect or direct technique.

    04:16 Just a brief review of each of the 7 types of manipulation we talked about.

    04:20 The first is counterstrain started by Larry Jones and it’s a matter of spontaneous release by positioning.

    04:26 You hold the body and you find an area in the body where there’s a tender point and you hold it for 90 seconds until it’s released.

    04:35 We don’t know if it’s working because of a proprioceptive theory, whether you’re resetting the gamma gain system, whether it’s sustained abnormal metabolism that helps the body think about what’s going on and pay attention to where the issues are, or whether it’s fixing an impaired ligament-muscular reflex where the body isn’t able to correct itself but needs some kind of guidance.

    04:58 The next type of manipulation is high velocity, low amplitude—the HVLA.

    05:04 Thrusting is when you take a body part and move it past the point where it wants to go, short distance, very rapidly.

    05:13 It's a thrust. Typically you’ll hear a “pop” or an articular release, but not always, and it does push right through the barrier.

    05:23 Lymphatics. These techniques remove swelling and help circulation.

    05:28 They’re generally softer and augment the flow of the interstitial fluids.

    05:33 Muscle energy is using the body’s own muscle and own activity to release motion.

    05:41 It is based on anatomic principles.

    05:43 You look at the biomechanics of the body where it should be going and the type of muscle contraction that would help release it.

    05:51 And it does have to take into account joint restrictions, joint activity, and general motion.

    05:58 The next type is the myofascial release and myofascial release uses a continued palpatory feedback— seeing which way the body wants to go— taking it in the position of ease, the position of motion it wants to go into and goes into easiest, and then flows in that direction to help ease motion.

    06:18 Cranial osteopathic manipulative medicine is now taught at every osteopathic medical school and it’s using the joint of the skull— with either respiratory force, lymphatic force, cerebrospinal fluid force— whatever force it is that’s allowing motion to occur to ease motion in the head.

    06:36 It could be the sacral respiratory mechanism, but it’s a soft motion that’s helping the manipulation occur to ease pain and suffering.

    06:47 Soft tissue is usually kneading, stretching, pressure, may involve spray and stretching chemicals and other ways of enhancing motion and it is a form of myofascial treatment which we'll talk about separately, but because so much soft tissue is done, we include it as a separate module.

    07:04 Those are the types of manipulation that are taught in osteopathic medical schools.


    About the Lecture

    The lecture OMM Treatment: Approaches by Tyler Cymet, DO, FACOFP is from the course Introduction to Osteopathic Treatment. It contains the following chapters:

    • Osteopathic Manipulative Medicine Treatment Approaches
    • Review: 7 Types of Manipulation

    Included Quiz Questions

    1. 7
    2. 1
    3. 3
    4. 5
    5. 9
    1. Supine
    2. Sitting
    3. Standing upright
    4. Bending forward
    5. Fetal position
    1. Larry Jones
    2. Hugh Llarry
    3. John Watson
    4. Hugh Watson
    5. Alexander Fleming
    1. Osteopathic cranial manipulative medicine
    2. HVLA
    3. Lymphatic release
    4. Counterstain
    5. Myofascial release

    Author of lecture OMM Treatment: Approaches

     Tyler Cymet, DO, FACOFP

    Tyler Cymet, DO, FACOFP


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